Skip to main content

Full text of "Medical diagnosis; a manual for students and practitioners"

See other formats


This Js a digital copy of a book thai was preserved for generalions on library shelves before il was carefully scanned by Google as part of a projecl 
lo make Ihe world's books discoverable online. 

[I has sal's' ived long enough for Ihe copyright to expire and the booklo enter the public domaLn. A public domam book is one that was never subject 
to copyright or whose legal copyright tenn has expired. Whelhera book is in the public domain may vary country to country. Public domain books 
are our gateways lo the past, representing a wealth oF history, culture and knowledge that's often difficult to discover. 

Mai'ks, notations and other marginalia present in Ihe original volume will appear in this file - a reminder oF this book's long journey from the 
publisher to a Iibrai7 and finally lo you. 

Usage guidelines 

Google is proud lo partner with libraries to digitize public domain materials and make them widely accessible. Public domain books belong lo the 
public and we are merely their custodians. Nevertheless, this work is expensive, so in order to keep providing this resource, we have laken steps to 
prevent abuse by commercial parlies, including placing lechnicaJ reslrictions on autonialed querying. 
We also ask Ihal you: 

+ Make non-commenia! iise of tha jiies We designed Google Book Search for us^ by individuals, and we request that you use these files for 
persona], non-commercial purposes. 

+ Refrain from auTornated qtte/ying Do not send automaled queries of any sort lo Google's system: If you are conducting research on machine 
Iranslation, optical character recognilion or other areas where access lo a large araouut of text is helpfuL please contact us. We encourage the 
use of public domain materials For Ihese pur|X}ses and may be able to help. 

+ Mainraln atliiburion The Google "walermark" you see on each file is essenlial for informing people about this project and helping I hem find 
additional materials through Google Book Search. Please do not remove it. 

+ Keep jT legal Whatever your use, remember that you are responsible for ensuring thai what you are doing is legal. Do not assume thai jusl 
because we believe a book is in Ihe public domain For users in the United Slates, that the work is also in Ihe public domain for users in other 
countries. Whether a book is still in copyrighl varies fivim country to counlr\'. and we caji*l ofFer guidance on whether any specific use of 
any specific book is allowed. Please do not assume thai a book's appearance in Google Book Search means it can be used in any maimer 
anywhere in the world- Copyright infringement liability can be quite severe. 

About Google Book Search 

Google*s mission is lo organize the world's information and lo make it universally accessible and useful. Google Book Search helps readers 
discover the world's books while helping authors and publishers reach new audiences. You can search through Ihe full text of this book on Ihe web 

at http : / /books ■ google , com/ 



- \ 








KYX'B. MuuhI of DlKcuH of the Eu-, Naav, and Throat. Bt J<?hD 
Johnson Kflt, B.S., M.E)., CUntcil ProfcEMir al l>tDlDir>, Rhinolorr 
mnd LaryaaolDjy m tht Medical CollrBt of Indiana, JJ«parlment of 
Medicine of Putduc ITnivrrtli*: OiologiBT. Khinulnviai arcf LarydgoEo- 

fht to Ihc CiTr Hait>iUl. 5l, VincFpt'i ifniuifil and Ciiy Disp(n»dry< 
tidianapolis: I'rlEow af the Amvricin Academy of OphlhalmoJoB) and 
DiQ-LArrnifDlDaTi and Membrr oi ib< American LirrnvDloeifal. Rhi^ 
noios^cil And Oioloaicm] Societv: tmie Ua»ar and Surgeon U. ^S. VdI^ 
W'ilh ite IIIuairAtiont. iimo. axa -|- sm P^S'i- Full X-imp Morocco, 
{lili Kdsc4 and Round Camera. %3v> 

ORK£NB. Msdicml DlwiBtLt. A Minual for Sfudcnifl md Practitionera. 
By Charles I-TTnan <Tre«ne. M.D.. ot Si. Paul, ProfMioT of the Theory 
ind PraciJce of Medicine in the Umvenitf of Minneaota: Ex-Pmidtdl 
of The National Aascciatlon of Life fniurance ExamlninB -Suraeonst 
ciCr W'ilh 7 Colored Plales and 13a of her lllu^tTationB, manjr bcinv coh 
ored. irmo. PuU Lniip Morocco, <^ilt Kdac Haund Corners. 

B1NNIE. Opo-allve Buncrr' Third Sditlofl. A Manual for PracHilon- 
era and Siudenii. Br John Fairbtirn Binnic. A.M. CM. (Aberdeen^ 
Piof^asor of Suraerir, Ktntat Slate Univeraily; Member American 
SurBicil AasociaTion; Membre dc la Soci^tt InfemBlionale de Chirurgie, 
eic. Thir*^ Edition, Keviaed and Enlamed. x -^ roe pa^ea. Illuairnired 
by nearly ?do KnarawinBin wmc ot which are pnnttd m ColotB, Full 
Limp Morocco^ <iilt Kdgci. Round Comfra. I3.D0 

HUGHES. Campend oFiha frmctlccor HadlcJnc. Ninth Edition. Givins 
the Synooyma. Definilion^ Causes, Symptoms, Patholosy, Pragno^iv^ 
Diaffnonii^ TrtnlrnenT, etc., of each Disease. The Treatment in espe- 
cially full and a number of valuable Preacrjptiona have been incoipor- 
ated. iiy Uinicl E. Hughes, M.D. late Chief Hc^ideni Physician 
Philadelphia Unapital: toi-merly DtTnoosirator of Clmical Medicine at 
JetTerson Medical CoHcire. Philadrlphia, Moth Kdiiion, Thorouahly 
FEViaed and tn parEs Kewn^cn. By Samuel Horton Brown, M.D., 
AnsJaTani DecmatoloirisE, Philadelphia Hospiial; Auisiant Dcrniafolo^ 
fiat, ITnivrrBily Hospital l'>iapen9ary, etc. Wilh lllustraftonii, Includ- 
inir Scclions on Skin Diseaaea and Mental and Nervous Diseases, and 
an Index. NiniA Rtvii^i and F.nlavtrd EitMim. 7Ba VHBes. Pull Limp 
Morocco, Gill Edflci, Kound Comeri. )j.&d 

THAYER, HbduhI of PmlholaBT. 131 muttratkani. General and Special. 
By A. E. Thayer. M.D., Professor of Paiholoay, L'niveraiiy of Teiaf: 
formerly Aasistanf Inalructor in Patholosy, Cornell Medical School; 
PaiholoBisT te ihc City Hospital, New Yorfc Q'lty. eie, BcmB the Sec 
ond Edition of the Aulhor'i Compend, formerly published in two vol- 
umes. With iji Illu mirations, yii paaci. i^mor Full Limp Morocco, 
tiilt EdB^t and Round Corners. %'-ifi 

't'other I'oiMm^i in Pr^araljon. 

Publishers : PHILADELPHIA 
















C(>p\'BiG»T, 190;, By p. Blakiston's Son & Co. 






This Hide volume embodies the author's conception of the type of 
book most generally usejui to the over-taxed student aod general practitioner 
and he has tried to make it a concise, practical and thoroughly moden 
handbook of convenient size and form. 

It is not a mere compend^ nor yet is it intended that il shall take the 
place of the many elaborate and valuable larger works relating to medical 
diagnosis, hut it represents an effort to achieve the requisite completeness 
through direct statement, logical arrangement, and the avoidance of un- 
proven or unessential theories and obsolete, time consuming or superfluous 
methods. To the same end^ marginal notes and running page headlines 
supplement the full index and the iUustrations, small in she though large Id 
number, are believed to possess the virtues of simplicity and teaching value. 
The author hopes that he may have in some measure succeeded in meeting 
the exacting requirements of an undertaking, the difficulties of which are in 
inverse ratio to the size of the product. 

For the kind suggestions of his confreres and especially to Drs. Haldor 
Sneve and Frank E. Burch for valuable services freely tendered in connection 
with the revision of manuscript sections dealing with the nervous system and 
the clinical .examLnation of the eyes, he is most grateful. No less does he 
appreciate the courtesy and patience of his publishers and the technical re- 
source which makes of 683 clearly printed and freely illustrated pages a 
volume which in shape, sixe, form and binding conforms to the specific 
purpose of the book. 

Charles Lyuan Greene. 
Saint Paul. Novsuber, 1906. 



PuLoanjuiT Rkkaid ox Cjut-tAKiru juto DtAc^vgora 

OunrnxD S»K9 o? DctcAax 3-38 

I Fadil axptaiirm indluKv, -i; drus. 5: colnrof Ebp ikin. ■;; Jaundter, 5; drf 

^^V ttoni, i5;^MqiMnuiloD»,i5;«u«. ij; hr«d. lO; r^^lfdv, 17, pyr*. ij-nosp, 
r i9iMr, 19: Up«, lo: brralli* ooi buccal ca^ty, bo: iLomatilii^ n; gunu, »y, 

I Icrlti 94; i&**. If; ImJjU. «5p huid*. 2%^ atm afkI Iciit* j&; bntk, ^7; )u£nl*i 

I ^\jhjn Kifurvv, ji, atiitiict, duttaJf ilhJ gull-, jj; decubitus, jj^ ^l, 35I 

I t>Fi|{]iL mhI M^XtU 36* 

Auu S£i, HAUts, Social State aau Rgildkhc£ uk DibtjuiK . ^ - . , , j8-4(i 

{ A(», jS;mk, 39;fa»>39; hftbn* and cnvlmiineat, jq; clrugbabl^4o: mtr- 

I lied <iriiAgtCt4ii<KCU(iUkin, 41; hftbiu » rvlaliun tu cccupAlt^t, ^j; otcu- 

^^K paXiOM blvofviaj mvnl^J ftlntiri. 49; cjnu^Kriiu Ibnvalvinf uat :if minrml 

^^H poi w i, 43;occMp»»ofn invnliHriit ptrwcitT h»t,44;occup4lianili^aia, 44; 

^^H roidttJCFp 4^^ lajn^Iy liUlury, 461 aticmiUlwA jn bcmlilv. 46; hcmlity, 47; 

^^V ppnrioua iltiiaws 49; mlfinAirLnl nilmrniA, 49, 


Srarrom . h . 

Wmotj of jjfncni ailment 41). ttva. 49; umpmiuir niiur tn iIk humMt 
I body. 50; pnhdagfc v«rUEion4 m i^inptvaiuiir. (;i; frbrilc lypn. 53: dug' 

^^^. notfic import of fnfr, 5*; |diciKnnfno of frver, 54^ pvlsc uidfaptration, ^s; 
^^^B cMMboUr Si' ™l>°'- 57- Uupar ozut ]n]urg>. fJl: p»1n.fiT;ch«ncta and 
^^^P MM ol p*ia, CiT;<Ali«, A»: ftbdomifuU |ttiB, varietis luJ au>«fl, 64: bead- 
^^^H ache, ^ BEtmlgia, &!t; Cfurili*, 71; nwaculaj rbcvrnviiw, ;t; icndcrneai, 
^^H Tj; pen«iK}an» oi »niiMlfoa, 73: Innimitfa, 7$; wrt!^. 75. ctppno^, 7d: 
^^^ aftb«pMC«,7t; varudMttiaiFipintoTyThjtbn.7N;Hc(DUEfe.79:Bbock trut 
W irHtpw-, 79; conccakil hcnionhjittc. fk3. 

f DUL 


DULhm oa mx Tbokacic Vuckva S»*ii5 

TopopaphtcaJ anatomj of ih« fhmt. So; njifonftt divuioru, Ao; ihnrvdc 
Tiacvr*! Sii lonpi Si; Tnubo't ■eomuaar spicci Si; (obnoT lung«,K>i 


liHSr DMvtDieau, S9; vocal fremltEu, 90; faewn 
of thai, <>i; AmotlUtorr pmcuiuin, 99; 
iMa, ^; lufif bord^m, 0$; i^muiiaQ of dM< u 

loe; pulmoAuy ana lU-mdndtnfc fp<nAl 4tlentJon, t 
VUdDili. lot; fllo. 104. luMuu^vc UKiloii. l□<^^ 
llippocnlic ftuccuuioin* s<rt>, friction icundji, ic^i; X 
chcM. io6( flixiruMUi»c*icru ■uilltidriijcnificinrr. tv^\ 
eunlrati. vmrklln. and vxunlnttLkn. 111, 

Immu nr tiik S<D>t, Piurtki, Aim LAOtNX 

Tvchnic oi ptuninjilton. 115: acuta coryn, tifi; (L.-... 
r ptiTro|:^7 rhiDELis^ 1 16; rjKstoari aod ead>aailna»r», ti 
ii7h »plJll henalnmi, 1)7; wplnl ■hsmi, 117; Jtit 
npcrt4ui| 0thnio>iii1i>» ^17; faflj-ffvcr, 118; nnml poln*^ 
oninumA, iiA, naul >¥philb, uS; cpfaUtLB, iiS; fc 
noK. 119; phfltrngtlii, v:urr, chrryilf, AAd iirophlc. n 
uiiti, 11^: »^|iTulitic phnryugilii, no; rviR> fluiryneca] 

|ijt: rttnnnir tonnllifit, f»i; cunplf, myitr, ■nd lubui 
fiiTuak Uryngitif. i»t; cdaB» uf ihtglortiik <A>< ?*<■■ 

jf|, kjpliiUiiE Ur>ji)[i[it. tt^. iu!itiiul«-iu> U^jvKiiit, 

IKE 01 na Bvosnrt, t^iTNos ahu Ptsra* , 


TTiHiwlfritl "tWiTMi t&i: cfaRMk Ifilentiliol pii«uiiionU» i&t; pa!ia)QU7 

DfUAACA Of 11U IUaii Afti> BuHiu-ttsiua (67-n3 

Afttrtil pulv, 167: pDlu tnquoicy, iM; aehynnlia. 169; bmlTCUiLlA, 
>6q; irTCpilAjiE} And mtmaiflcscT. i jo; KfrhylliniiA, ifaj varictiok of pultc, 
171; drUnBbuUon «f UoD<linmuiT> 171; tphysnu^jcnph, 175: t[^yEiix^ 
gmia« 174; nermt} Mid kkcofnul Eradn^i 175; vcnow puUr, 176; duatoik 
>vnou* cdUpK, 17^^; f(uii&vr pcnttfAtiit; vrn^ui pubc, 1771 v^fblc rapEn- 
liV7wnouii|il»niinnrfl;i, 177; tnnmSmsicm aj ikt h<att and gf^Ml UhikI-wuIj, 
177; spa buT, i7;;difpUc«ioii«lAl«pn b«al, 17K, cjit^lic rirticiian, 17H; 
pRCDtfdkl (ndutioDi, 178: pututioD in reskw of nunubriam, t^f^i pcccorl' 
kt bdifln^ 174; paJ;iUlaa ai preconllum, 179* ;itrcitfslan of prrcnrdiam. 
I T^jjMCullalidO ol piToaTtlium< i So; heart bauzult, tSi;rcJupUi:4Eiaa oltwBrt 
vaDndKt^i^bnrtmarmura, ifij;hmiktnannun, ]S4;ptcuro'pem«Jt|iAjiniic^ 
murtt ift5;>cdidiaiial mdnnim, lAjiorgurtc h^ftrt munntin. ittO; rhjthm of 
nvpnk nnrauir, iBgi reLittv« frcqidoncy «i Duroun, ipc^i hypcnrofjli)' ^nd 
dfatttkn, iQi; mini RKUipuUion, 191: b^nlt ilraceu* luj; trii:u»pLi] nvurti- 
litkn, ipj: pulmoiury timoflu. igj;nittn! ttmout, i')4;annir rrgiiTi^lfltion, 
i^jl IrioBpId MnuMkj 197; pubftonaiy rrfuri^ljauoD, 198; congenita] h»rt 
doBuc, 199; yataXtnt dodw vtcrkftu*. [■»; iTT-fHAie^t jh4Li(. bltuuuk. igi^; 
OApvoulioa virl incwnprntalii^n, 399; intpAiml ri>m[w-]iuiliu0, TOa, funi* 
plde ineomptfiBAtloita lOi; rvlotiw insudGcicndn^ 2«>; jA<vj^ii£ itfttrUm, 
XHi X-T*y la diagnoddi at ftncuriiiD« kh; t^miiiaiiu of ajtcuiUm. 30$; 
aamfwa of fir«l portion AlMcb, aoS; juwiuiBn ol toifitvrnc portion a| ±Tch, 
M^; diff<pcntial dkuncK* of anouriun, ti^;fiidoaf4i*ii, >iy, wiihncutc en- 
<iKUi|Mli. )i4;«1centlvTcndoc3rilltb, jt4i ditQiik cadotaidiLls. fi;< prri- 

cwifilB, 118; dkrcoic mfocuidilu, uS; mplun of the be&rt, ijo; auruHjira 
ol thr hntn, t>t>i furrign bcidki In ibv hran, jao;nvwpc>wth of ihr hiari, 
»>o; niu viiaruin tn^twuK >3 1 ; tmrii>-»clwoiit, aa 1 ; layni p«tQri», toi^ 

VVMJkOt or TKI A>DOIUVAL OpGAffB 113-376 

TcfK^Apb^ AAtl rrKimul diii^k^iii* »»«; Iccbnic ol jibdi>ailiul eiiMulo«Uoa»> 

blv pfffiAilik, «jSi Ht«r, ifS; ^l-bbdd«r, a»^; tptvmi 030; kidotTi, 931; 
itoJiMi, at^t; pbpic*) enmliXBlJoa «d ihealamadi. t^%; AomiKh iuIm and 
ru WH, vjA: iK-tmSf of innflfhidSon oj «oniai!:h lubr, VJ7; tmnlfullaa of 
IpOric eonlab, aj;: leg^t iiu*l^ 93B; qiutiUlivr t«BU for gutric ««*laM4. 
«^; te<A for KD(0i ^vct cif slumacb, J41; (|uanlit4iivc Inlj fnr (Ulric 
f — HHi. >4i: end rwiloni. 743; hjrftfrchlorbydiiii, «ij; cfcronjr hypmr- 
cmiAfl, m4; hfpoehbirhydrifl, 14(1 taachlorbi'drMir u^i htttrnthyM^ i4|i 


gBslik DcuigsB, t4yi Anaiisia, V47- buliuLa. ui> oaluu uid voaniiing. 

m$a; |^ric spw, flSJi jpflcnc fa]rprraUuGBi&, »53; gpitnlgu. ajj; ehtvou 
dtjiprpBiU* 9Si'' uioTciiii iKimoa. 754, BcfayUii ^ilrka almplcn, 154; gHttic 

chrofuc diUlat&H), JJ71 «ciilc aiDor. jf£; pytf-ilcnotk moTcj iMnAdMiey, 
3$$; huur-cUn tvntnciijii, i6g^ u,u1c i^tMriibt 161: chiuak ^smuic 
QftlBfTh« *6i; gduttnc okw, >te: dunckn«J utfvf. >67; ulcer «ilb ftdhNlon*, 
tOi gftslrk crMtom, t4S; oirciiionu. »f>j; ^uTiIc cH>a, »tii artcrio- 
■dcroik ■bduain*! crkoi. ift; f»yphi]l» ^jf ihr hLarrUiCli, 171; tuU^rcuIcnia of 

MttrfiVf, 974; tbr Iccin, VT4; akwopfk <Bt iw l n ^ n' oM, *fs; teMdifCiT^i 
cocicrdlcvuL^rT; hfnurrboltK ^^: tmafd^ »7P* i^viv tnilodn*! iKuUps* 
ttoOi »^: AfuTe femtMitttSn diurWift, 3B»; direotc cnlertiia, 1^; cboten 
JDiwCvin* >$o; djsmlcry, jSo; nrmbcwMio cnirritii* iS.i; mbocIUscouB 
■J nninvn, »$j> rhrr^nlc tnMtfaul obilfuitlcci. «R4; <hiva(e Intu»- 
fiHCVflliOh, >#!^ conilifttlioB, )45; f«c«l •ccumulAtkCili, fl8A; d«tt4«aiJ Vkw, 
>ftft; ffaratAtxjMji Ahd rmbUAEv, 1^7; lulicnukudft of ibc jptmloci, t$Jl 
ijphPb of Ihr fntnifam. *$;; <ii>(rrq)lMi«. fA;; Hpi^'^'^l^ 'B^- r-hrcmlc 
•pfiendkitis, t^t; Mute fRhtoajtu^ a^t; kx^har^ ptritonitbi 99*: chronic 
prciluaili>i vojl ^ifuliTrfAlivF ^xriUiiuli*, :rQ4i lubcKuEuta jicrikinltlki *04< 
r^nwr, «p;: JiMivi ji/ 'A' jiiiiifrAir, 11)5; kruir liRiinrrhnBpr ptWftilStU. 

ctmnJc puciTAUtl]. ft>6, puicfruLif. ^y»lx vqC'^ c«rclnamA. i^qi^* ulcalE, 
V^: dJMiArs 0/ fW /AtfT ait Miary patiagtt. 996: rongnikiikl ■nomnlLn. 
t^l iBflamitiUHMi ol Lhc livtr, t^ji pyBmic febamncf iht tivn, 397; htpA- 
tk hjrptrmin, «og; tumofB of ibc Emr, ^w- cdiinccu^rui c^ib, joo; dr* 
rhcah of tht llv^r, 3«i; ntirrbnl jBundln, jay^ uviv chotnyiHtU, j«5, 
cboktflUub, ^s] iiculc ytUow airoi^hv, 50S; ViVil'i djj-cuc, s<^; ihe^tta 
fft '^* UD^Agfkfp 309; (fcOJtr fvophi^llB. ^^ori: Mriuum and divtitkula, 309; 
nmni»n«, 310; t.pi»m, 3:0; iiriiwJ^irif <iHd HirAitri of Sh4 bidmtji, yo\ 
yrisny «nmiB«llaB, 311; po^yuri*, 311; <di|turiiu 311; f^ufcty uf mic- 
lUfflkm aODd <]j»urfji, jis; cTunpai in urine, 513; >|icii]k t^nvily. 315^ 
uriiuiy ulidi, 316; um, jso; albumimiru^ 394; (■<<l< ftir tJbumin, 377; 
puft^ 33t; blood, 331; bUc, 3.lJti '"^ '^ gl^nw, ^^^'^ accloiu, diftcctic 
acklpOod oaybmytlt adiUj^J^; eijtmJnjiUtin of urln*ry unjIcncnUp j 39; uiu, 
344; bttdth In unrvc. 348^ goAOfo^icuii. 144; thrlich'H cliAJO-tnctioa, J49; 
"'•tt'*. M«: ciyotCDpir, 351; cryoKx-pr, 3*^1 rmal incAcwacTp J54» 
chfwaii: putivc ixiDgatiuQ of tbekhblcT' .15SI ^^^ rongaUonof tbckld- 
nty Aftil ■nn^' nq>hhtu, 356; chronic pirtnchrmiijui ncphritii, 339: uwiU 
nliiLc ItidDvy, 361; chronk lutcrM^i^jd iirtjlinln. jv6i; chronic diSux 
ntptuJti* villi eiudjiElon. 304; ^mjlniil kiilnrv> 0;; mni^b1« ami nunting 
kiiln«y» j6j; jhyrUri* ami jiyrltinpphntif, ^ft;- renal tubrrculotii, 3ft*i b^ 
droMphra^, 369J ofwtt o^riti, 369^ <hranic cy*1ili», 3^9; tubcnutoai* 




U>44f«, jjo; tUBUn of liw bbdderi ,170; uruf^ prr^Hiii, 370; chrnnic 
rti dijUinrv dkWIiSi 373; dbbrtc* imiLpuluH, ^75. 

nifKunai DEn3c&t3tT crpooi on AxcoaATm wtnt Ciu>nint in ni> Blood Ami 

Dwn±M GUiXtM - - 37*-4»? 

EmnimftJwfi of iIk Uow), 376* ]iitiiibU4ue). j^Ci diDltal IcbU. ^TJ- tarnu, 
J7O: color Indn, j^H; atMAlnlng lilood for mmlriAfion, 378; prrpnntim od 
tliilc* ftad «ottf -fllJUM*, J7i(; fa*Ufi|L n imfu, J79; fitmg, ^79; exuninnlion 
of Imh blood. 579^ tliininjt |irc|uiia£ian», ^So. Idmcji^ljuj. j8t; IctLa foi 
b»«w^f»Wi», j*i ; h«»oj[lrt»iiiitim(n*p», 3**; TalJ^*f*, 3HJ ; fJirr't.jHj; von 

arthjd, jS^; «r>fArcwvfti unJ tfukmylo^ j9^^; (cJ bluutl cell Uimdiirjfj.iii»,, 

;; daniafUiofi of IrultiM *1fv JAA; ^bnorauil fjVTM, ^^AtninriTtnl T^ih- 

lonnii jH;; vtusud cnihroc^lic >laiiiiB|Erf«rti(ina,3R7; nvirlcaCnl 

cdb. 30j; blood cell coum. ^. IpuLoctIc couii[. ,^^: OU\rT'* hcoKi- 

-. j^t; the fcVimRlAcrlt. jqi: IpuVocyiMU flrwl lyrTtphocyioftfa. 391; 

of d i w» i> «t J9j; IrukvpEBniu, jtjj; hmphocytt-b, 394; TnvbQ- 

,. 3>i; nriarurmb. 3M; InlupkiliB. y^A'. iHrrinudcat UuopMmp 395: 

>g^viln&lioa rHftlon (Wi4Uj, 30^^ courxtny of blood plilcs, ^^; coftguJH' 

lion tine, ^96. DlkaHailj*, ^C* eTlpdUgfl<3*i>, 396; inuHOpy, 3^7; Jijcau^ 

»; Ab t^MnJ. 3^5; aa<iiJu> 398 > tymiNomai 3uA; v&umb, 401 ; cMarosIs. doi ; 

tcc«odMy AaMODU. 4^^ pnnitioai umnii, 493; apLflnic antPAila. 404: leu- 

kiank, 404; afilaKancdulUxT Iculutni&p 404; Ijmphatk Iciikcmia. 4<^A; iivlj- 

Cjlfcrmia, 40}; n»1r/'fc <tiitniw, 40S; KudifLIii'iL i]iu^i>tf-, ^iA, iruir Hodg- 

fcta^ft dJMAV, 409; purpura, 410^ purjtijrji hirnutrrhiLgiLa, 41 >; h»(Eii?philii, 

4<ff; AOorWtVBi 41.1; Addbtni'd diKoac, 414; lympbAli«m, 416; m/xcedoat, 

416^ cmlnbim, 4i7> mynmtoiu In <ululi^ 41^^ Eiophilialick golufv 419; 

■fnmnply. 411 ; ci0«ftii drIottMDft, 4*4: Icontiuu <■««, 414; EnicnuBigaJy, 

4^4; pulawnarf hyfcrtmphic oticvftrthropalhy, 494; riL^LcU, 4143 EDbmUUBOu 

4^6; ofaartty. 41k 


Typhoid IcwTi 4^; influcnn. 4jH; Atbtlf cholcn. 44?; bul»ru<: pJftguc, 
44|; fdk}« fcvtr, 44^; niAUrut 44^; nbpsiDg (eveit 4*,t: typhtu fcrrr, 
453; nullA Irvrr. 454; mtlk fcrrr. 4 j<^: oiouiiLitn fevrr. 4jA; mllUry f«iv«r; 
.loot 4ibd raouih eIumap, 43^; BrxxS (cvef. 45^; Ula-juv, 457; inmlf«. 457^ 
nn, 4S^i lurkl JtvcTi 4^^ r«1hcJn, 461; Hiphtlwrk. tfit; iai*U|iuju j'^; 
470: nrtcrllji, 473' »Uici|uni; cEiogb. 473< ^T^llli. 475; i**^^' 
iuij inUlb, 4*0: lyphllk b^mtii^H* twda, ^ikh^ tryilpelu, ^Hi; pyvmiA 
UmI tqilkffaiU, 4^^; ^^V^^V' 4^> »itbr>i» 4^3; maljjtninl puslulr. 4A4; 
I— Hffll— mlliiv fib'rrui, 4S4; taicmkl iliiIIitsx, 4&4; hydn^phobla. ^ht', 
•rUa-flb, 4WS slnft4a«, 4*71 ■ctmomyajwi, 4<7- 


fawtwlTi 400; bent rxhaiDtkiD. 489; AlmlioUiun. 489; cJitoatu xkoholiBai, 
4S9; dallhum imnftii, 49a; morphirw and fcninr babitt. ^t^i chniuc L«wl 
pononisf, 400^ chrooic ancnkal poboainR. 49«i pi<JDt*mc poix-ainic *niJ 

;>cii«oDLng, 49j; luqua paluaLag, ^4. 

pAlUtTlc iJaxAKU , , , 494-^7 

Khbopmlflj 404i dnBcLIaLjii 4V4; (ichuIlvU, 4^; ctstodtti, 41^6^ lii|jriroiin>, 
W^, ifTvu uLEinaU« 49$; fmia ■u.tlWm. cgj: ImihfHKinphalus Utut. 497: 

H oido, (loo: omyurlA vcnmculvU. 59&1 tiiUtiniui*. 501; uniinjLriuia, 501; 

i lUadfcrii, 501; drftC[<inllaiU, 504; tHmcpphjduii rlJ>^pHr» 504; ilur^nph^rme 

I giipv, ;e4; wtxcxigylaicls inlvvLuulit, 504; ptorotpmniuii, ^^ UypM- 

^^H CDpiH srdH^J, jiyv; pf«llcul(u cBLpi[li, 5106^ pnlEfuluA nvpoVk, 546^ psdk' 
^^^ uluA pubi*, 5i>7; vigabond't fllkea*o, gay; timrx Icdulftriiu, 501* 

r Rm-uuATir Arrtcnum. - , , , , , . , .$09-511 

Acut* rhcum&liuiit 507; inf«cticjUB nrtlutu. 5001^ tuberculous ulhiltif, 509; 
bi|]-juuil (liHKvc, 5L>7; mbotulr ilicHmalmitH >wg» (ouL, 3U9, itrrieulDJ COW* 
^to; arlhrilit drK>nTiHn^ 51^1 cbirinir pmgmtAirf ftrlhnlii delofinuu, lii. 

Tvs Nbivova SrsnEK AifD m DncABEa , 511^11 

SmiftuR, 5i>; mode of ftCtkn, 513: coDiluclar En mntitr *nd wr^rvy arm, 
5i>; rcdcm, 513; tnotw liscU, 514; diicd ftnuory tnci. 517; Jadirm ■««- 
Hiij tfBU> siB; fvncticiu ai Brnwry Ija^ta, 519^ funcuoTu (if Ifae UuUof 
Ui* ipJDfJ cord, 519: tT»« IfiTolvrmrtil uo diKUe, j»: Umu uncommon 
iix, 5it; EiigJogic (cclun, 511; UegcoemUoa, 513^ cIiuilicAtion, 515; 
■cijurmr of ilrcrticmiFvc L.luM)ea. 5?^; tcU^i^tii vt psIbuLutk changn to 
lymplomiitalo^, f>5; vnviiy crnifn anri pdiThw^yi. j»5; gitdir ■pnuOontf 
5i4l Bolor LmIomi 5161 imilMtnl ipickl cord Icncna, 5*0; cocnplcu tnui*- 
vcQeif£a*l CDfd loEutit, J37; ilic rcQ««aip 517, uuabutloii of tlw iim»cln. 
%^t; crrUin ptirchic jind tcfuacT drnrnfrnwiu, 5^; invnri|pEbcu of Hfi> 
MIT fimctiou, s^ifi ««^Mfii Jio/viMi/, S3>j eoTM«, 5,)q; fflmt mcaj, jjq; 
Cdtlruoi acmlm^, ^1; ;ipik Uuluniu* 541; [nicmiJ <A|BijlDk $41 ; cnm, 
541: corpora quadrii^fifab*, 54*; pom, f|ff! mcdulU ubkmgHU* 543; nov- 
bcUaa), ^^^(i tfjc™'*^^ /urdJ>»fj, 543; bmchial pArxVM pusljw, 544; <«n«bi 
ipinal ncm, 541^, cram^f nrrrtj* 551; uliaiiuty ucrti. 551: opilc ntrrr, 

Ifvt, find fy* reflew*. 553; iry* rrflfi**, 553; opiir ncrtr, JJ4; ophthalnm' 
»pr< SSi; reiiiia«uipy, 5sfc moMi nerve* ol Ihc cyt^ 560; lot* kr Wdcw 
of ihe jrd, 4lh> f4b CLcnta, ^i; uUmIiI nervf, 5G>; liiUi nrm, 563; 
MVCAiii nenr, 563: ivlti >pura «Dd p«rBl7«ii, 564; itutjiloiy iifrv*, jA^; 
dgiinCTi, J165. M^Ditrt'* diKWc, 3652 |^0M0-ptufya«M) oervt, ^, Un 


Tifs. 566; ^4mI u tttM o r fmnr^ $^: byroglomf tttrrr. ^fR; lyiapt- 
ihMv m n w *TtU«), jCtt: ^uuivj vf Ihf Iraitt jrtS $pimAi <af4, 568; hcinur* 
Aft^ padrjBKiiiiilplB. 5^r Bkuzna] pdkifiyEiiciiinjpli*. 569; ntiii-intJi£nitr«J 
brmuniup. £65; cainnn dUnur. 570; milbry kHotkh^ 57©; multip|« 
kJug^, 57«; orebral coogsdon ^71; CftrdnJ ia«uu, 571; ccrcbr^ 
edema. 571 • tluumbiM£» uf Uxccrctiril *du* uui hDw*. 571; mealogltUt 
571; tflirt, 57j: riiMr«i[^ n-r«litrH|i!n*l fnrninBilU, 5J3; ncuTe tubcrculoia 
imK^iWi, 576^ sypfaUidc nvflinipl^ }T^; Alcoholic Diciifaj^td, «;;, ace- 
cndaff «ftd tqicli: neafngiib, ^7?' inkDilIt rar ainglEit. (7^7; chn>nh: mmln- 
l^i*. 57"; 08»fr»Sf»l hydrwrphfllm, jjl^; hyitrnnplulin m pduti*, 57*; 
luflM^i of ikr bfim, 5;ll; Antral Fi<cton in Hl«iv>fi in tumcir irkniiijEMipn, 
j7^; tfTTrbnt bnurrlu^. mbo^ism, bimI thndnlnaLi. %U : ctrtl'tui Atwc*«, 
$H6; pAxttlylie tirtantU, 5^7: ■imnli ol thr <T>n4, ^H^; lhrDiab»ii| cmtM- 
tdM, rmilMterilff of (bf cord, 590; looomafor AbuiA, $^; atuk pAm^fu, 
(43; Fr-DUy anabinnl >dcRJiS», sv^; ht-rrdJUn^ atuu. i;g}. (m-beOu 
lHmLur7 tUJiiA. 593; priouirf UtFfal Klrmu. ^j; ^'nliUry «|iuifc 
■fdntl piar»)yta^ 594. vptflic pinUpU <if ioFftnU* 594. h77»1ak apMtk |tt«m- 
plr^ 5QS; •BKiuni'-ic fainilx iiCocy, 59^; *yrtoipiiniHia, 505; «iin|irmioin 
BjFcUlk, st^i noje* mruwrw mjrtrtit, ^t)6\ jmrnjity ctmnic otTfliiiB, no*; 
l^ndij'k panlpb, ^m; ifolkunrcliik 4AUriur hlUji. 51^: progmtivff 

VrophiCAi 6m; pMi^do-mvMuW hn>«tJi>pAi7, 603; Jimuj «f the mmidis, 
604; iayt>toak, 604; wimllKniA jtnvW, 604i ntfidili*, (04^ mjndcU <^\h 
iciM y ^cgr uri w, Oai; pftntnTorloQuft ffiulllpkx, A05: ■inn l iw, 605: 4cufe 
frbcil« pBl7iiai«itd« ^5; inuc n<iiridi« 6o4; beri buri 6o6i rocurruil luuj- 
llple nurbb, 6o>6; |ikwu<c fUJalyMf, 60;; tvn KfdUtagluiEuni'h dj^fiuc, 
toj; aetfftlgU. 607. hrrprv «»Mt, O07; prriodlf truuLmi papjjjrit 607; 
IU7«Bwf* liivAJC teij frythntnfUlgiA, Ae9i ocrvpus^tbciu, 6o9i Intn- 
mtiUrnl yuUil rduhvu. tica^; uijpijuciiruLli; ckIcid*. &09> Ucfal hanlAtmphy, 
On^; 4fiiMfty^ 6vo; Hnnn. Ais; cnnmltnT tlr. A14: iffljiiEUrtu Ik-, ^14; 

frij^ iwiaiiltiiili AjS; muioiik fmrwtlKnU ^d li^^trria* «J0, 

iM*"J*«"»o &»-*i5 
SauUtnl mjurr, &J5> «niimaiirr fc-^gnoi W«tn, 674P ■unaia, 634: &n)Eina 
jtf<««u* ni4; iptfiait, Aj4, mthnu, 6?^, itirtph^ ol the carimnitin, 614; 
H MnJneii 614; ClAOcfi 6*4: tmUilqMjri 616; rxnfbml coacuialtm, 6j£; 
H choivft, 6a6, wtituttpttkiii, ta<i, «ttrtrul&ic», Ih6; wnvuislgiis, tof; nitin- 
H «oa» Wicoi. A>7 ; diurlvia 4ml fiwnlfi^^ ftf7; {|jtipf)\ rcltiai, uil «ActM, 
' 6)7^ ^ptp«k, t^j; Cftlniti, 6>8^ ipilcpsj, 6^8-. tjciIiaaBo, 6jA^ fci^ial 
iktp. 6fA, 0eTfT| 49€i ficiitkiui woondi* 6jS; batturc*. 6V9^ hndirhr, 6vp; 
■ hrOcrrhjflH, ^\ bffhU. 6j>; bjiltafrtr. *jo; h7(!nke«ptalu4, 6jc, bpdfo- 
H phobUtfja; iMonliac&tF af urine, 6joi mMtuV) 6j&; J4imdiix« ^jij juinu, 
B Ojii Uvptait Aji; hnnbaao. 631; coeiUi^j): piJa uut [«niirraiM, Qjt; 


punJysLs, 63a; peiitoaitia, 639; riicuuiAtiami 63a; retention of urine, 6jaj 
sdaiica, 6ja; scoliosis, ^sj; scurvy, 6^y, unconsdoiuafss, 633; v«D«rcal 
diMuea, 633; vertigo, 633; vomitiag, 633; wry neck, 633; condiliona Mmu- 
lating dealht 634; aspbyiu, 634; calaJepey, (^34; syncope, 634; algat of life 
in one apparently dead, 634. 


Mineral acids, 6351 aconite, 635; aiKnic, 636; atropia, 636; canthaiides, 
636; carbolic acid, 637; caustic alkalies, ^sj; chloral hydrate, 637; cocaine, 
637; colchicum, ^37; croton oU, 637; caator oil, 638; corrosive aublunate, 
638; fonnaldchyde, 63S; gelsemium, 638; hydrocyanic acid, 638; lead 
&«tate, 639^ lobelia, 6391 mmhrooot poisoaing, 639; oxalic add, 639; 
opium, 639; phosphorous, 640; potassium nitrate, 640; poiaaaium chlorate, 
640; stramonium and hyoscyamus, 640J atiychnine, 640; tartar emetic, 641; 
tartaric acid, 641- 

Tablb of Apfioxiuate Metbic EoinvALEHTS ^ 64a 

Centiokade a^d Fabk£\heit ScAtEB .......,- 643 



W0SIS.^«4 rf«y[iw*i; rnearn morr than a;i^^^il ii riiim^- lo a dittuj^c. and 
mail iTiduidc n owrwi oiimwr of ilic i^jn^jiiuiiouaJ [*iuliiiriiirt iif rhr 
|ift1itnt, the rulttfc mnd cxlcnc cf poiholcjpc duuijcn. the dloci <J njcc^ 
<iCcupAtfMi, mJdmcr, hftbltK. hnrdirj, put ftilmmUv and rvpn thr ppr- 
ncul chancdcristio *d tbc lAdEyfduftJ Accunttc djAfEnotfia and inlclU' 
gmt progttotit &» p«rrcqviBi(« lo ftflociivir [V^AtmeoC. 

Pfooi fail lirxt-bonkv And tbt lecture tuom. ihe tfudctil lumai ihc 
hnown lypwj al the b«iii<Ie he »»>on ruiJizB ihnt >>nfllion irooi ;hc 
typfs Sft'i thr prnonnl njiiATl^n tntiitl )w rmn-fijUy tfiidicfi Oiaf;ma9U 
im wtciikint-. <tifn mart itian in aurj;ery. mttji be tdW upon a lagkieMj 

biv or pmofUtpHtm. Sdl "Jc^cpuiin ipclb failure, oicloo th^i nvroncd 
monttJ vUon. whkh cmnct sec and Jipprvcinlc new Cuinoi laltfrdevdop- 
inent, or thr cowstnitt thai f43fcj> in |{ivc up »n crioncmjfi pvfcoactp- 
}iatt. Oai knowlEdj^ af {fnioii tymptom* io n pven cbm dcpcodj 
dlhrr H|»]r f*> ti^itJi ttt jrr AiW nr ili) ipA#i/?(r vr <ml/tmnin< fffr />Wfi 
jK/t«f, j^ they »re triUicr U} juijVffiiT oc (bl flt/Vcriic, ilic latter ^mup 
induding bACtenatogic and (hemic t»t« At veil ns phyn-jcol ai^s- For 
the ^Tnoer. wc depend ui^m Uir (jaLjcni. miU ofirn em d unlet i;ufrulity. 
alupidilv. cqncc&lmcat. dtcril or h>rJOciiiM(lrijk(al cxui^^fraiLion. U 
the lalkm h oimsUtAr nr in^tfraso ni> lontimiri bnf^uafir. *t hdve 
M teadmoDT savr that of Mitddrnh and in any evml muE»t cx«rd*e 
taunt] jurifmmt, kern dlicnminaliofi inrl a n-nnin Uctliif- in cr^ts. 
ctjuniiitfiion oi ue connnt ^wt Io IhcAc faJUblc yet t^iuAhlc »iibje<Uvc 
<bla iKtir prt^>cf wdf;hL 

Td miike a uiac bi9loi> full uLiuiAte. ;« evitiisif. hi etiiil tte Miieul 
fa<^ And awi^ Id etch it* (irojvr nJur md j)-'ri|'e<ctivf dcmondi 
ihiitt tbe itt>«r\rr Iw fuU M kiiiiwldjn'. iiuirk <jf |4T^rptiiiri iind rsvpaSle 
<rf aviddmg bnlh the ^o«ii of ornlvion «itd [tie n^cki erf TurhoHiy, 
C«flAin matinc mqnirin; should alwap br mnde. and the dudent 
tboM he calreinclr lui^rul «nd jninMakhg In the d&jt of IE» a|ij>ren- 

Ira ifikOr 

" ir«4ruy 





ticofaiph llkOUf[b tilt ikUkd diald&n ctn MtM irpon the otfi&ti) poanli 
of U» A«» ind arrive it ctirrect conchuioiLn in a. oimpanlivplj rfton 
lime and iHih a minimum waatc of wordi *nj ink, CtiUin r^^e 
(jmptoms laay uamt ^c durtse. %n6 (uch flfc turned ^lhogHt>m<mu. 
but woe to tlie raui who b liclrft/cd into tbe Aodtl of indiiiiiie "wiap" 
di*gno«it. Hit opportunity pMcad whra p»tholofry aim? to hn- 
fttatp. Diax^sU hy exdttAiitn it k wirM rhwigti niun<bt>uui ami 
often unaUisFaclory method of vrirjng tX condufiODa by a prtKc» 
of n«Kfttton. the object being lo find fn thr tlgnt or tymptomi pre- 
xolcH b^ M gkvcA ttic, one or Aorc mconjJjtcnt wiib Ihr iJiufcrKAtic 
tfoaptoaa group of aU discftAef tsve om. Modern tdr»nc« h«i gre«tfy 
nducfi] Llir vduc d. Mid firu«u*ly (or tljc mrthod. TjphoM nerd no 
lonj^rr be libortoualj MUbOahvd by ncgstion, but In iJmoal erery <ii*e 
may be directly and pramptly disposed by Ibe WidiJ teat tod iflflMw 
rv^ctioa. Its simuUt^^ nuUrid^ is so Icn posiivtly knvwD by the 
pU«modiimi u fev«aled by n bTw^d eismJruiior, tn wme inctsccet 
ft Ihff^^calk ^fiHUiV b nc<c«4Ury- u for cx&mpl^. in ileAlIng vith an 
obomrc or inorrit sotpe<tfi4 fyphiUtic infr(rtir>n when mcTcnry and the 
iodirira may baniih all doubt. Miifiy ■iiirfpnt* nntl laime pnirririonera 
hftbiiuaJlT (li&frio«c me<4ic*} oirionrtet uH wdi ^oiiM remember IhAt 
ibr dAftHne nf pmbflblUitei U >9&£bii thrm.anrl IhofoughTy thrv«}i out 
Ibc Tftriiliont of llic proMic vnd simple liefiiire assuming tbe long odds. 
On Ibe other bind H UlU b9 the loi<>f ereiy mui lo encountff mrJIie* 
snd llicir rcoognitloa nwans Addetl oedll uid repursilon- The i^iMtck 
never hcsitcLts Id tnak« & diftgnosu. but ibc physidsn of p«rt». Inowlcdp-. 
And hnresty must oftm mukf none nr si hem a pmi-istonsl onr. snd 
w&jt for Riar« licht The quack ncrcr acknowln!^ an error; ibfi 
hore«T mMn «hstever ht< abifity must occaiionslly conltst one The 
moiT igaarsal and dislianoC the man. tbc mnrt docmA'ic nrnl rapM 
fail diignoeci, Cor vrith brcftdlh sad depth of knowlcd|*cfumeai(AM]cbeM 
B^ft a cpnceptfon oi iu llruliallons. The pfayslciut musf nork melbnd- 
Icaily. ddJbcrsldy, ^nd with open mind, but once hv opinion h fanned, 
\t ibnuH fin<i emphntlr nprenioa tad «ver^ tub»^ueni rader xnd 
act be chmderixcd by £rmncas uid dedsion. If u> thr»c i}i.ie1JiiT3 
be addft Ihst modeil teir<onl)dene». bom of fitlceas ot briowlrd^ snd 
rcsonne. bis are Iliic kc)S of the temple of bunt, fitidi a msn r^r snd 
wQI deal with tnidURtol palienisfiBnklyandfrrclyH he will not be afreid 
to c&n counsel, anil rteed Dot Irel t!iat hia afternrnifrrrnfre v/]ih his 
conaullani must be hdd in prlvalc acoordinj; to a pervtllmE <uMonj, 
, mon honored In the brvacb than la the observance, l^re an few 




TU£ oimVAin Stan or oistAu:, 

fukiliw of iht toMll5ginii ton \n iHticb the physician nnnot find a 
'^*«*^''' vliQm he CAn Aijiml to hU funfennco^ ulk nilh frrel; And 
bouMlfi and tbenby inovftie his u*«rulncad And j^iin ■'ddcd Juppurt 
•nd ft mJti»hlc i-a-nprnilnn. & aifi) ihtjr. in lev ji^yskium vrho vfd 
v*ca visii of courier uitBCftn»(^f if If •KKmnrtificmcaL orlhcliuicDiA- 
lion of ft fe1]o«r prartitkin^r, ftini nn'* wlio ''innot d^l fiirty with all 
pattJca CQdceiiK^ n oui cJ plate in ihh d^y dnd gtticmiiun. Doubttp 
fcftfi Aftd BJgummt. hcwTrv«r. are rot for the nctroomH where ftcott'l 
fnkni Ixaring and diceij caunlc:tuncc idcilii oftcntliiK? more than a' 
whole p4uinacofN««. 

Let iV sdivlmi Vwmtf of that mfihivl <tt Wndy which IrM-k him to 
atfaJBuOr commh lo taetDorf a loas; train of tymptani'i) wiibout proper 
cooiiJffatian of thnr genenl bearing, caum. or «pedd and pr<ulm 
idiltOfiJ ulhet lei him Icam to omocuttcr with cadi <lif>ca*e thai whii 19 
ia pocatiar and apoci&c. A vuiliitide of dutcAaca, for eaample, arti 
febrile bsl ferenan much alike UTrjctfiKthHr ^rral Bymptoinolo^\ 
Thu Um be afeould leun tborouKhly u od broad application, but aUmp 
fipcdaHy vpon hu icienioiy the fitadky iypc of fever or dcfinLlir vtrU- 
tiofu tlui Ally Kjim dSiea«t proKDta Fufdjcimorr. eiery s^tidrnt 
should 1*7 lo ^( a drar mmiit fJuiiffgnf>k r^f any aabnent he ia studying* 
and <ti tke palhulogic chui|^ that uncitrlte and ciiikiin hs symptoma^ 
Lb bla min^a eye be should mv the raaa with typhoid, (he chMt, the ' 
phjnrioqponqr, aEtimde. ti:^ fpott. ami mare than Ihat ihr- rnfpfttnal 
ulcett that sftilcHie them. Sucb k mct)>oH makca fut tliup?u};tine9 , 
attd lor ^ukkutt of perception and Inference and no man can take an 
iMelGB?nt compirbenohe nxid <vncue (uc lilatury who hta ncil rnas- 
lend theee pnnci[Ja< 

Ftiiftly. and mo»t rmphitiv-ally. abcmid it hr stiifd ihnt auf'inJUiti^. 
rv»ntt*V ^^ tt^trfin/- tk^nUd ht tarried inh tvtty nitrit protliti. 
Old caw boo^ veil kept ate miaea of knowlcd^ nnd the; icirncc of 
taaBdoe «ftjn1d be Kftatly <»richcJ were the wurkria [n dt> lad hamLet 
aBke bo ^t* to It reports of the unuauaJ eajca now fr>r the moat part 
aBowtd lo pwi ttiihottl leoonl.* 


Every t^cnmU cnouncncva nfth titii infiwlLKiiufi lo Ihe palientn 
onderenlbchaadahakemayeDnveyinfAmiation of value. The pbysii:^an 

«Por« fuQrr dEacntakia o| ihl>i rr>pir Ihe trader ti rrfrrTrd let ihr rtrlfahi' 
M Ivu^ of ByroiB Bnunvrfl eoUUed '*rr>cilcxl Unljcine matt Mrdlc«l 






lOCDICAL l>|AO^Ottin 




Ft«iri and 



should (minhIftob«n^Hllon;Ln()wi>dfl4r>«HllopTitulitPi!befi»Tnpl«0if 
bjaprtdccmor^of > darker mcdioUrfD. who were adept* 1^ force of ne- 
oc9»ity. On the oihcr hand, he thould ivuid huTy phj-tiognoniic diAKno««e, 
fgr iipi^cftimnocft &n i.iftai tnivhlt^ii^ DloftiJu^i* in iIimum: vi \\k none. 
Iliruat, eye. cai ^nd itkin th v>Mmti;Lliy that of iosp^cilrin. and thrtnighoui 
ibc whvhr ntji^' uf mcilftiiu: iml sur^rj ii playft an iiii[K>rtaAl pan- 
FACIAL £XPR£SS10N. Characlcr and temperament, bud hMu* 
i\iaetLte% |)M« an-l prrscni, mjiy stnnd rcrtalrd at % 0nnc^- Tcmp«n' 
mcnl j* da»c]y nJaicd Ti> diathci^Lx hul Iho Un<t im|j|irfl a Icndcncj' 
ID tiinir K|ona] lype nf divow. J'hc lumicr has UiU Ihir provniJitni 
plau: it tirld in uiiliirt limcb. oud unc nfivl ^jte liitk Ihmight Ii> k% 
«Ub^jnk ctiuiibcalion. though the "ncrvouiL" " bilbiw." ''phlcKmaltC." 
''lymiihatlf^" ainl 'mpliiinholic'* tyxm arr aficn clmHy drflnMl Jird 
aid in diaxnoMi and pn>|cni)itL» oJIkc. l^lio for cxomplr. troa not cn;'oijnl' 
«rrd ificr "tjFinphailc" ind^*><lual niih a tubfrf^uJitHk which humi Mm 
tif ctndtnk whik' the phy>idun tita;;da Htlplras lu aLay of cutr? Tbc 
'«xpntonn hdpi u» viih tnalinj^rtniH (J^fl« forg*n of aymptonv «hr» 
'scpk ihdlfi uncJrr the hnsjHtal roof or wfsh tn widdlr d^map* for vimc 
, HpUAoo* hurt iJ|Hin llic ricK in<livtdu>] i't l^irfMrati-jn Jn the hanc 
do^ rtffiAjp' aitd *hiftin;tt eye ol thi* \iiiith, and hi* moi*t dummy hand 
Vft may repaid the sLory of KituJ abuse. If mrlondtcly hoa marked 
the paiienc for hrr own. he cams on hk fare the Lnipret* of htr *i^9i. 
Endpicni inMinily nf other ijpo ma> maniffM iitrlf in a jnccullar caprm- 
bioD of thv eyn^ "^ititero^ttcninin oi rmoiLonal cxpreaion." oa it hoi been 
cwlUfl, flUil !i (tr*c-(jlin'ly mrrry rYprn^^wifin it ofim a. 

Guienl P«r«ab ia Us early itipsoftCD icivaoulvrard e>idcTiU7, 
Lips, tongue, fingm and facial musdn are iirmuloun; thn pupLU an 
iinci{ua1 and ncaa ip acaimmodatrjii bul iiul to Uyfii. The apcnfa 
it «lr?w, heoitftnt or cjrpkxuvc, conAcnuntal wtirds arr difikuJi for IIk 
violin, and hi^ iMu^rnn^ of gnndcur arr hkeiy lo find an ootid In hta 
convermtion Even^thiaj; of hU ia aupcrlali^-dy bcautful. limplc or 
grcoi, and he mcompLonblc- 

Ctrcinooift ol the Stonuch a fre^arntly A4«>dated with a curi- 
ously in{i' 'T laiLimine e^rrwriri wdJ nhnwnin th* foiTiOuftatfitiiFof 
Na|Kilr<on Jji his ImI daj^* TLip, log;clhcr with niarki^il rmaiiaiion 
and a fKctilmr i^tfthy colur are mooL 4UfX*^iw. 

SjphlUt.— Thi? <<ni:niing cry, ^vorened monkeyUli fnrr. fiuiLmI 
|I|tS anil frtw nosirili cind buii^rLinfanphiUlicbabf arc|iiilbi<j^i'i(TLi.tnic. 
T1>« {HTinAni-r;t ufi^rr t^nrml in<i»'>n: of the r^ldnr f hlldivn arp hkely 
• In the Cftrroron Gallery, Wni*lniEtnn. 

rat OUrWAItp KGHt. fir DnXASK. 


bepqt^«dgirt, inv^l»aTtLlf«p«r«iff<1, 
ton nuy ndfatc fnm ibc an^ciu of the movih- Kciaiilia 
cfanmic oUtu mcilia ofun ct> eiin. and m anj affc n fro^ TcLfc (mc 
tinltiw) m^y r^iili from nrrriviEii ai tfir nAwl jirrh ^jphlhiic 
cw QUir be prcscnU or h«Tc Icfi ito mftrtt ic^ a iHtlchy jcrayncM. 

aa rviddkcc ihai can bt^ delected in iht 
ordinary cumin ulion, the mrninrr being 
liifiril U' trU iijHin thr i^tlcni^t i^lAtt-mrni 
it) rri'tv Il> ;k dirvn 4)Uc^Ui>n vliMi thouJd 
be rft^l^nilHj iini1 flt^ilv p«l in ihr ri*'' ftf 
ihc iiirn though manifestly imponil^lc 
when dcilinjic nilh wcmm. One of iht 
must ciLAll) reiEi^j/i-il and fiitl^i^iiTTiimk 

lyjfw <na Wt lAiiHr h4tTi nr ■Knilrmi iirrAd of gny hair will^ «ailak 
" octfe und p«tfor«tfd paltLtc^ A deeply 

fimifwl limgae mggtits ihii di«r«£« and many <aw* <i| confic prctrnt 
llicniMlvci vith an ncbSv «nd uiiim>uIvJib1c fEujpiiun tir "dn* |)riiiiar<r 

DRBS5-— I1tc iiinliiy fif drr Hof liinfi; and iti (iitiditiiin may fu^-»i 
riie poditioa in lif« ol \\s wearer oa wdl n* l>a occupation, CoHesJy 
im utd ttinmnprrl garnicnifi. iTolncd b)' bod dropplnip nuiy ftERpAt 
r«9ct3ABl c^AflffC; p«inicLilArly if nuloj fjn a per>rin forvkcriy nc^f tidil wdl 
■•d carcluUy dreuni. An ammoniacal ndi>r ■vijgMU inconlinmcff nr 
cjMilB^ A^(J wlitic bLhiiw upon ihr slioc^ may j^vc a hint uf an ctislJnK 
CBcdntint ib'abctH In paElcnta formerly flout who have necmtTy 
grmily in w-dptt ihe old clnihrK may he worn and Iw njppi'Mively 
On the other hand the dcvcliviimcnc uf an ni^iMuca may make 
Ibc patlefil appear en Iv huniing thnmgh hit flcthinjf. E-Idemn nf 
tiw IcKB (» frrf^vmllr auKgokd b> Loo.v iaciiks of thr tl^ucs. vhiili may 
b« cut aad ittanhtT'l fnr the «uru^ reitvrn ot (he belter lo ncci^mmorhit^ 
h«Bkina nr gouty tfiK tn thr vflrioix^ fnrmt nf ]ulholnpic pilt i 
wearing airny af Ite ikh^ in a ;wrtinjljir p^rt may be lugge^rivc. 
bring partirnhrly nnnrruMr- In tTic ipjiOif (r^ndllionR 
THE COLOR OF THE SKlKp-Th.; t»Q amiULJoiu chidir \o be 
tn F^ilar and cyanr.i«ii ; Ihe palf fftce m^iy ormajnol mean \nxv amr- 
iBua.Nnda kiik tfljr may rofiisf ie^ a Iirw hmtasilobin pentiUaii. 
UoR itmi may be lai^l lif-^Tl the color of llie muctm^ memhnncs md 

ifiHihlr. J 







'■ Pawn 



lug 1«llf<«. 

choo^ CtfttAn <)egrf«t of paUor inij pijsi Ihttr without uunvbl vv*fli 
"KMijdibBDtkft" uauoU} »hgir & fwlc conjuntlJva, Ordinsiilji one nwjr 
rcgajd pollar cf ihe checks, ij^i, lonjruc, thront, atfs. cffnjtrntfivtp and 
llager millit m in<tirjiiinR « iriftifiyl hjtmnglfjIiJn pcrfrnuffp The color 

<tr aTmfivt WHiy whiTi> in chJorosis or fimpTr anemia, ■ jin'iilhr Irnon 
ytU^i* in pcmiuuus oiucnua, and a, miQiu mnh^ dot m tbf profouiKl 
Kcondojy onttDiici of matignant diuow o\ the cromoch^ 

la Acute Bri^hl's Disease thr tkin U white and od usoclfttcd 
tdemA prvfiucKt (hr jH^culiarnndGhaTncUrnMic/djiy^dJIfff. Inportm- 
lAjnukir^iHf (v/Ariiif «<r mf«t with [ullor or in il* Uxt kM^ » Mltciv nr 
I brownbb hue- Ma«i nDlhor^xpHkof ibc pcailiAr "fn«ncotoicd"akui 
\s rvblcd lo inkmitioJ iwphntu< but in the auihor"* efptrwrct- il ii more 
often max with in rav« which come iintrr Lhc "mijicd" ij'jic uf chrcuii; 
kidtLGT dbt«A«. or onljr in the Lalo «lflgc« of the intcnlitifll form, the 
c&rllcr pvHcnl being ofTtn U9t>cuil«d with ihf niiMv nr hi^h tulortcl 
{"dubman*'] coonlcavicc, imd cujijr of il» victinis apprarinj- cxubvr- 
uitly healthy, 

TJic cuUif Id crrliiin fumu of heart lUscakc ia butb IntercstinK ud 
iniportABL A^rtU regurgitaiian h utninlly aasociate^ with n pallor fit 
|}iF intluar itiirker lyftr. 'here bciu^ nrrly tt\y mukeJ Irur tttmiA, 
but CTtA in compcEuuicd rci:ur]9lAnt nnd obtinidivc discue of the 
mftnlnlvr the color itofien decr;)titdy hE^h. proftucinp; in ^t\% npfdaEly 
what the kitTrceardAaBaDci^uiBiLc complcxioo. tbuviffli tjiu!< la women 
tnd iA m«n audi re'hitu> of lh« cho«k> is likely lo be IrM i^-ncrally 
dirrtrlbtiteJ and more paidiy. TTip sJt filed p^r wm the Juakincu of 
Iht underlying c^nnoab which ihrrtts yet more pljunly in Ihv mucout 
iDembnnn of Ihr Hpt. thi* nWv of ihr fSTn. nnAr in'l [uiHIa, ftiiri the 
raQb vhoM i^nk ia rcplmxJ by & (Ltiikcr hue or in TMrcmc cama by a 
purplith or hkcktftb gny. 

I CTanOBtfl vhethei general or Inral. vlth or without true tt^ipnrx^ 

I ordjnArily incUcalea obatnicted vDnoua return, deficient oxidation, or 

tomiDiviIr both fartnr* unrh m may mult (mm orrfinnry mflmaiion, 

ooAjCenilal heart rhxaac, asthma. unphyacRvju pulmomiry ftbn^isij, 

ohflTnirlftl gloTlfa, Itachea or bronchi « from f^r^lgn borfl«. ni^nifi, 

laifia^peal dii:dithcri!i. tapilLuybmudulbvr brondiQ-pncumuuiu [i^^iJcr, 

I mvdiA«(izu[ lunort. of other heart and lung lesiooL tt occ^tn ai»o is 

i acute dii^dcsi «uch m pneumonia- or pleurisy with dlljcT ti^iuid or 

'jcaMoUB effaiion* ftnd Id a atiehl dejET*** Ea teverc acute t>ron[:liktii. 

I CaralysU nnd tpavrin pajticiilailyof thf dfaphngnx may prndtire marked 


T1EK OLTWAU* BlCBCl <tt DtStJiSt, 7 

<9«oQw u mxj tbc iithibiltoit of cAucni rc^inr&lfoa by ktcic pftlo. 
No oilwftnt <jgn or dlMttt OGCfnli cyuioiU in importinoe ind «ne 
shovt oA to dift^oib fjo in the fft.ct Uuu ui iVj ^xtraru torm if exijii ifi 
M 9mQ Jftfwi 0/ imMi/ ^Mhntr, rir,,- severe cmph^-xm, in the 
L flDOSndul luMn dijvnA?, In ihr ciiltfi ti bi nitm MRviHatni 
ttOtt cUlUnfE <^ tLc bo4y lurfiicr. Li>BtcnA, ncurilb. etc. I^^at 
vaiiMvaEcr fWAToi^aa or ptnljift It ntdUy flivtlnguUbcd ty lh« lack 
of turgUil; of Ibc vcnoou uuelI^ ud it iboiild br tcniEiiibcrH that 
certain fonai of dcvg p«soiUDK. csprdoJj DcctomNdc and itt cnnfcen^n 
iiiDi>-baucd,ctc>.Buy«iCcauut for tnotiienvltc incxplk^blc ind ulicmc 
cyMMiil Tbioivh cxccnlvc heat hou cymodc mtm arc cottf save m 
natttij MvutA ima Tlw «Ught«<r d«gn« arr ofl«n unnotlrrd tiy 
ihcMutknl btti frttuttMwd cyxfufxit A3Bih>l htcverioffM. Of the nary 
otbtff dfpvtunA from tbe nomiij tint one may mention lh« jfHowiib 
bmm. dArk bfoini oi bnmiUkh bkck of AddinftCi diiOi\e. the |M:culiar 
blukh tf blackiik jpsy of dripru (dirunk ailvc; poiAf>rtin|c]. the callow 
llMof NuCiif^aoiltb« v4f?ingyr[lcw«pnQdurTilb>'i0Hi4fiV«, Afimic-al 
m t Um m t auj exKtly Andate Adduon^s divox but luudt^ dimiouhn 
wuhr drugdwD on tinuflPce. The ytllowiih brcrwn ^ich^ oi pftgnaiuy 
(chbuvHA gnvidanjm) AnA pcJvk ditunlcr* nn comuoD «nd ruILy 
reoogaiBMi. StrcftlLy plj^tttniation ii«U4Jly indic»tfe tcnichinjE 14 lh« 
rcKiJtof akinpftruhoor pttuillclinioniL ^«/dr»'jaKr>ffiui fft juaudaird 
with n ^yitb or bUckiah 9km and the urini? iSvm melftnia. A 
brmrniili or dirty gray tportcd or piichy diKolormlion may ncnir Id 
Jfctf ^ d tftf drrk^tis Tith or m;hoiit jftuniike utd brunjcint ina j br Ai»fxiaTcd 
wilh owabiiKd dnbotk «nd diab*m fbronj* dlibcu«). Au<^c from 
iU iccuniiuy mlm manifcaitnlkjii^ lyphita in h^ Icriiuxy aud uin^mital 
fom pBoducOT ft p«cubftr mikm pUior not euily deMTfb«d, but nAiIy 
hme4 by obsRvnlfon. So br u ib« authnr** obsrrvarinv ffftn ii it 
met with dudly hi odd auo of imircrfcafy imitc^ lyphilii, and ia likcl; 
to b< atBOCoUifl With othrr "irfnin^V n " PwiilUr but iadrfinnhlc 
tana of pallor m&y mirk the t^taim and^pittm liobiiuc. Ixat obirnvd 
in lb* opiui* decw or ih« fpcdat h(W]H|ftb oJ our Pftdfic Coast town* 
or in the Diieal^ Tbe ftutb»r hu dbaerred oursi in nfaidi ihc ipfmr- 
UMC wu remofkafaly like that of dimnic nc|:hntis, but mtin ofirn the 
bafall Aty «xtsi for vein vHthoui dlsttnciivf fnTTwnn) sIgnK. A good 
color ikould bv evident ibrouf^ut the body, and t)ie T>ink tkEa of 
hmtlh ift 100 urdl know 10 rvc^iiirv ■ dntriptioA. Vatit-mf^iUif ctmirrK- 
Dim pn>ducco local or BCQeral poUor u docs aa indEcimi poipbmtl 
circnlatioiu A pj^ Joe* b common io jpout, eorlj iblcr^liUbl nepbriiis 


Cr«n(ati In 





U|itun Mill 

V» lull 





Hat iiirh' 


K.f J— lin<n't ]ii- 

Mlt^C' iJilf. 


wd fanatic dnfwids, bui may be dut lo Mkfvynmty,Knt nmnmtft 
expocutcv It often tUKKtsts mn uvci-luiuiiouB and aetf-indul^ni Gfc 
<ff Iha tUuM of alcoholics^ Vmiai^ot fittshing U often obKrvcd in 
lalMr iniEumuuUH or mcrt^ piUinv pnsaurc. migmJnr, And Iok mnnuiatf 
ID LTriintion of \hc ibro of tlic ncrvkal f^pothcifc t* In wtcutCttn 
of thf jLortJc nrrh. jXi« rcfnirdt mnrkf^if n>Uir low nr mori^cAtfAD fn 
CDontciioT] wiih rliranii: [|it<A«ca, h tibodd be bomt in mini] thai Ibt 
lympTom ix At 1 m^- on-' imliralii'e ol thv idr^ttupJ stage of the dlMfWc 

Bricht'fl DUeaa*. — ^Vakir rrom zlic cobr rhjmK» nrfcrrcd to m Ibt 
p9«(Eding p^Lfttf^raplx Ibv cxirniJil appnnuicfA in Brii^tiC's diacwe mt-j 
he vimrwlui chntnatriuir in rfimnk intiTyJitiaf ftrphrhfv nnrf *tt 
mart £& chronic imrtrdiymnlgu^ 
rvphriiU Hiul iniv^ Rr^i^tv 
Id the CrsE, Llir diicf imliuiltoTi 
u lound in ihrl^iKlmcyloiyJcmn 
of the tjtAk]t>. vt\rcdMXh td the 
toacr. In tudi ibc polcn puffy 
l^c| almn»t Innihirvrrf lid nf 
foHy momini: mAV Ucti in the day h&vr bccomr ahrvr^kcn and wrinlilcd- 
ITw Coftdrtiofl cjutcof be conniderrd MS (mthrt^dmoriif, hiiT should hr 
rrRH^^c<i Mt HUKtc^tivc, In dirunk pafcnchymAtoia and in '^mbscd" 
nc|)hriti«. ihe h^ mty n\na appear more or 1ms puih'. tallow or wra 
itirn oih>rfil Tliir aLii|;Fa v1 tilftnu will trr ilittuxvtil uDcftr aiioihcr 
hading- In acute Brij^fs dbciuM-, the r^v^-nlUr \iAtxy white and Lhc 
crldcQGM of edema irr dutmciiviv 

JAfTNDICE.— 4/r:^fiu,^ Jaundice b cither 0^jirH(/ivr, ai in direct 

or indjmci iiilUmnuition t>r ohttniclion of the ccmmoTi duet, or ttux^mk. 

' ihr hllet fvrtii bt-Jiije nfk-ii Aiuu]dj Idrijcd hrmai%>£rnm»s u opposed 

to kfftilr^tnoui. Bath (ypr« ate cMenttfttly hcpAlic a* tcfcardi the 

toufiec of bile |Hgmeni. and '^c^wmnlion"' ami '(iiffuiinTr' jnuncUcp 

cover acMrly c\try lypc. There iire tokinca which wi Jircvtiy upon 

' ih« blood n«elf {wkhln the hejmde ii«iues) or afTtct thr bcpatie nUv. 

. Puboninie; by |ih^jf[jliijiUK iKiiUKJan) chlorate, cthrci chlorofomi. loluy- 

tcndi4inia> anakt wnom and arwinic ore usmpl^ of anc fi^rm- ycUovr 

fevrr, pyemEu antd iii^l^uii uf anuthcr. while ^rtdiii liLfCUMs urc 

odVrUfr/ by a marked asoomicd jaiindior. Such urc Weil's di 

and acutf >vllfiw atmpby (moJlgnmnl jatindicr). It ocni-utmaUy com- 

;>Ucatcii purMimoalo, ulccralfvc cnclocarditij. iypMliA o-nd ^ren influcnxn- 

rhe typical mild jaundic« ia frrm In ahnple oturh of Ihi^ bile duciL 

The term "obctniatve'' to uBtiAlly appUod roven an obaiructlon to 

flUow J 

the pUMKt or bile from chc Hver to ifac i:\tctiltnc& itizh n^ulunt ab«ovp' 
Cfoct into tbr ||VTif«^ dmibtEoo. ThccautH slft vwrcgaEim-ftuodetiitii^ ' 
catftnlu] condilkma inndvlDg x\it <!ucli gall ti'ine. or pAfuilr* in thcf 
comiMQ diKt> prriinin: dcMur* bj tutnoi of thai or adjaceai itruciurtv, 
■Jill wfy nidf by (ecaj iciniinuklSon. tlir |jrF|*naaL utrnis. of jill 
alnktaiail iaicuiiaEi. Strldty ipeokiaic oU ca^u of jaundin ar« 
filMinjcilvr &t fTcn in ihr- laik Tonn thcrv U a hi^h rbtciditx which 
Uvon BbsiKptHMi. TW R-mukablc jaumJicc B»Kialj;il vritji menlAj 
Ahock ur pnrfoQnd enolion m opruid^rrcl b}^ fli*rli'r U^ in; obiinicilvc 
utl if idolHtlr dur tu if«»m oiid irvcrsrd prriiCjd^ia. In oni: sudi 
tax comlftjt under the muihofs notice profound jauniljn folJowtd 
A meir At fd An^. Umbllin Jrff ruA may mrur r^irk In Krfn:lr. dt' 
riwrii or Mcniaon {tundicc 01111 llur vuljsunot apixar? \n ihf urine, 

SymptOdBS-'-'ni* tkin. iVidLir ffli/uH'ir!'^ and mucnUH ni^iTthnnm 
of tlw ihltMl jiirJd Ihc Ix^t i-vi(Jciicc, upccUJlv ti slIiJc-lIci] tj ^rraurr 
hf A niaiOKVpc tijdc or a lumblcr. of mrtdy blanched by finger pi*i- 
lUic hmi nvfl a mvkid Siutiiiuii4iffm may Ttf invisiblr by aftiptiat lif M 
ibouick dkflii^t atrofTs a o^W which on llic alua tiAcIf vanca from a' 
dkn or lirflfiani yirlbu' 10 a rlrqi gnyn or bioner (mHamVlrrut), iomv^ 
tnnfli limvUEini: Addbon'a divaac- Ttto cue* of ihu oort ««n 
ivcmtly by ihc auEiior wen <\w lo Ihe Eoat lUiflra oi dnhomi ol the 
Uvri mad o fallioie hcAn a«Mi4i€d wlih KtncroJ AnaMrca^ TAr riroif 
aaJ HriiM ar^ 4i$cfA9rf4. the tnll^r often yi^^ldiniE thr hr»t vvicjencie of 
Ihr (iindJiifHL l)nr putv u oAn iIowtrL ihe srimb arf f«ilr ^r^y- i3»My 
aad fetid, ciUicrooiiutipatioa or diorthcu may tw prucnt Aud there mar 
b« a traubWoofoe pntiliii- ^ MoirW ^F/nmrp^djfv rf>rffn<v If fhcuf 
m Mwnr fouj And is of vpcdd intcirai to tli? aufitujii. There m»y ! 
befn&rfccd mental dqmotionor vvtrcmc irrtubility, and in cfTlaln cA«fl« | 
CQDwUons, tcilvrddlriitrncur&typhi>rd s1ar«, i^rdin^ [irrhd[J4 In coma. 1 
Sud) roMo an* moat cocnmonly iL^adalcd vilh Ihe Atute infections' 
aod thr |iuftv ard mpintion arp matizedly ilomd, 7nv moiffv^inrl 
finrndicrf acute jxIlavF airofkhy^ ia a rare Hiscuc of unknovin coiuatkin * | 
ckiefly nScdinft wnjricn aed ofim rt^lod lo prrisnancy. sometimto lol 
tioiml enuHkin or shock isK \}. jofi]. | 

Ictonu Jfooiuionim, — A mild type u virta-niely commoti 10 n«w 
bant ehilrlrrn, ocnirriTig dririnp ihe fitst 1^ or 45 houn anil LoiEiing for 
A wnk i^r tva It ii beAiRn and unimportant. The icmvc toim U due 
to wpBtk utunllf of timbiUcal m^pri, iyphfhtic discav nf ihr Kver or , 




■■041. JiAcI 





*Bui tv> 
i<i6 (Oiln). 

aiv 9a rtttiEil dn^ ihc fiial obaoration by Balloiim la 






I ViHkhlf 

ooa^mittl aiNBtiM of Che ducb. It » ftvqitmily tmooMfA vftb 
beqo f ifcuje fnun 1^ lurd And ii i kuil dl*fujic- 

DRY AND HOIST 8£IIT. Hyperidrouft. .S«t«tintc ol Ux 
hAndjt or ift^ ni«y imUrAri* Hifi«jrcniAy. dHjiliiy, nr hr &n imUckiinn 
of acunadicaU and cspccmlh of sciuol acuroM^. UniUtcnl sitcMmiCi 
eq)0cbB)r oE th« bfsil or fiM. lik« piUor or cyaooju. occvn in prrwufr 
iafolwfnenl at Ibc lympAlhclic ccruun migninc!! and nirunlKaa^ 
Svcjiiinfi ftf ifac bnid u csjicdftUT common in nckcu u)d ol hnlf tbc 
liixlj En nrr iiuitLncM of hemipltfgU, GrnrmJ twcaduK onunua 
' critical phanonuMu in certain aoiIv diMuee, u an aMod&ted tynptom 
[a maLtruJ fwpr or phlhuu xnA f^niSiBDlly in aoiie rhfunnAlf«n. col- 
UpM, MTcre pain, eic 

Anidroos.— A dry tkin u aMo^taicd with di*cnsc«cntutuigttproFiiM 
dUcliar)EC uf iWI h> Lhvbowcla^-T Ikl^ifyflanilUflpranounccd^yrapUMi] 
in certain of \ht cachvuta wbnc lltc ^ia may be UoUi diy and bonh, 
diibrto. chranic inlnvtiilnl nephritii and oininoma funiUhlag good 

QuAlitativ* Cbangas.— 'l't>f yv\hv irwat^i oi jdundice. ihc blue 
aad Unjvn, >dl(jw. ml or evrti bemmrluj^ic pmpirsliun vi h^'Sttria. 
the didgutling a<hyn cf bromidnuit or the uiiaotia odor uf the (weatlng 
aeaocuifpii wirh imijalreri mini limc<{on may be moouiTtrml. 

EDEBtA- -Tlirrt term* afC u»ed tn Ihi* connectian. edcn^ pf^P^' 
oonfmml u» ihe tctual connactive cinuM; ilf^pty. iti^ acntmtilallon of 
£vid in tic scn^u* caviUu or iboc combinrd witb cdtma; «vMMtf(V. 
(ffcneral edema). The Uil icrm however is very generally loed lo 
IndioJi! a cnmbinadan of the two- YAttttiU rqjtrsrnti ■& cuers of 
Cfvuuded Jympli over the abaorplive apadty of ihc tissues fLnd oaay 
b* obflnirtlwr* ^passive oongfitloiu). bjtJrvmSf (iftia*min«» Infcriiocui, 
codiexiu) or in 0iany Ja^tvices ^ oombinati^o of UjUi- l^creawd 
permeability ol the capQljuy walla ia probably a prrkrninrtit factor in 
ibe tatter if noC In botb ^upc. and experiment faits 'm piiQVc iht (jJder 
ifaoory of hr^nradc plethora. U- incrcaacd blood tuLamc and woter 
mrnibn, Hw dlMlactfon Vn««« infamcnaiory cdrmii imd onnBagr 
edema b Uirgdy dependent upon the phyucal oonstilutcnU of iht 
in&iinrti4lory avdak u compuied with the simpler innm^ig. 

A Ihorougb kikovledce of the faraiilc IooiIloiu niid the la^^ea of 

diU condhjeo b Abvoluldy otacrliaL {muniuch as it may nkitt \\s sent. 

obey ordtmbei'lbe Taw r(fKTaviijH»iin.«nd varj from twi-IlmK nf the Uda 

' and jUifht puiGneM of :iic ankles or a IncaJiicd anpo-neurotic edema. 

\ to that dixlrcauiag ocm<fition known u genfraJ anasa/ra. In nhtch ihr 



ptttitai b drowDinic Id kb oki» sccrctl^xu, The icnn- ampo-fKur^lic 
tfdwMfl i> Affilbd eo » Jocalind tn4 innflrut Arm swdJmg closely ' 
dbd ta unkvb adJ cr>l^m& niKloimA, ciol ofUinaiily pilling on 
piworew found lift mmcu n^Rions of ihv bn^dy in crfUun ill 6t£iic(l ' 
ormdhlMii, ftAd b imuaIIj ai hut sU^l icirrr*! nr Impntbrncp- SUghi 
amd twuKXl Wthm of the lover cMfcmitic* i« bund id cue* of ftnemia, 
or ilttr pwionyd and txhAiMting iramj* in tlioar »n»c?j|i«anKl to I 
phpkit QRcrcbe, The ctdJ^lfn»tic fc4lute of ell cdtnina b Xht 
appeuBnoe cS 4 ntniifig due lo fiuiJ in the connoctivT tisue spuws. I 
iMiflU; to iiufrtfy 14« fwnM^ uuJf^ of i^ n^tctol jnTliun. rt&dily , 
rftvrrjiv «W foe 4 rubiblo period ni^nin^ iitJcniali^tu from prtvurt 
of themminvr'sflngtvorcorisiriciian dur co ckidting To \\t nttfrnt 
pwla ihc aftmc piwcaa kmds h product ti^uid annhtt in tMJt stri^ui 
e^Mm ^ ihe plrun. poncudnni, furaa vftgmolu sn^ pctiioi^cum. 
pfodudng ihc coodickm kiKm« tvpcctlvdy m AymCAffiiur, hydntpett- 
tardiimt OMi aiffi4M, Sudi ojrtnme offiubns flcoontp4nyin|; p^nrrnl 
rdcitift foc^uto "gcnmJ uiuam.** which in pnctioe k IJniflDd to 
DHftbt't dlv4«e. M A fiilii^ Lcajt. Aa Ulwccn l!ic»e tvfo oondltionA 
iJw altndaat edema al limc« prcunM oomc duttn^itliin^ foiinMi; 
Id hewt dbcax t;ai«al nkuu (tirciJuniiuLiitlx cbblruclln:) even 
wilfaoul pnunf uunrciL b BOooated wilb qnnoob ojtd in jl* onginal 
MttI ukI progic» ifiHiDlly bUmn Ihe bw of gnvivf. rommendng In 
tike feet Aod cxtcffdioii upwnidi. In acatc pofcndiTnuaotu nq^lirilb 
ftnj nurli«d edent* (hjulnnnlc) uaull^ «ppun fini m tlif fic* ind 
cjcs And ciltnda iJviviiwafii& bcii^i; aa»Dculnl wilb niukcd palkrt, 
nnlMd wilb sn^ ootuidonblv d«p«t of cytaoobk unl«io ihere bt 
olnUwlivc dfiatinii in the perilaD»T arity or tharuc. or a cDcrpllcaiing 
liilttK OQ Ibe cardbc aide. Funliennon; the cdcrrut ttf fiiij^fa 
iBwme IS ll appMn on tht body jtenenlly or ihc rzErcmltlPA, b db- 
tiiKtly finuT Qianbft PVMvrfcaribt edcind. and In those with aiJdicaic 
tfeht. EBioco fopMlally in diUdivo, on« may finrl thai Ihe kg* pnimt a 
■urUf apprwice. the bliM wpcr6di] wnulA auiliaating with thf 
dnd idiitc of Ibo skin. Edi!Toa of the cj.rdJac or rtnol lypc b maritdly 
■fencil by Elnni^ in the prulibm nt ihr jii:lrnt, ih«t rd hi^n rl^u-;iv 
eflp«<itlly tob the iltfiudo awunod by «uch a cnac duriciR any tti^hl 
bdDgofun todlcated £nthomomingbya*inCTna«drvelliDgoftl»iidv 
upon which be haa lain- CanEac cdenia u^tuoJIy Ei^qxan 6iat m l±ie 
oKft dqtendeat porlioji of the body, aa in the f«ct and xnkUt after a 
da/« activity, or ofpt Ihc wcnini in thz liedfMl . The t-Uj^hlcr etlrniiks 
of the lower dtrtmltlcaauywhoUy orinpan djaappcarduringani^ra 



r <i«>lai*i 












resl in he4^ A ccrtun fonn of hud edema b occoAuvuiUy mcl wiUi in 
thott oirioui rnjvt Cn whkb Ihe pnimi ix ablr in hff «bam for tt^ris. 
uiontliA c»r jctn. In *jucc uf a ditonk rdcnia of tlir Wrr cjiumkltles, 

I of rrcunuot ocofim, aad *u rcsbisnt tiial prahngtti firm pmmn U 

necfSMTj/ i0 Mm/ jf. One ihotUil not be mUlcd by an edema of the 

' lowrr rTtrmftlM. nwpe ciUttt unilftlcrnl. dup in var*fii» vnini. rrirmji 

<>i il^ ,i]vi> wiitmijt t^tOA of iIlc anble w oihci rvgfou liu bMt) 

CoUateral Localized Edema.^Ovi^r dl purdml exudates w svp' 
|puniL%r blinmcraTion such fdcrna xijy, but 4^s ftfft ahfay$ ifcrw^u 
f<>r fianijJp. in cmjiypmi*. muii~ilclL<^tH paroiftlis prrirardllH*. hrpallr 
«b0CC«*i |>criftC|>hriiic «bicie«>. rtr. Nrtn-lnrtammaU^Ty drciiin»rrilje<3 
«dvriiU»rv fiilirr vngkwi^amiic purjiuri^. gUm urtH-ari&h>r|KE?-ilifphi 
cdenu of ihc or4iDAEy obMructivv lypc. biktrrKl if of thr cwdiac orr 
rvaol ly^v. unilaCrraJ if due to the biockinf] of Eh« IdcoI dirulAtion 
Edirmn irf the urnt ntay lir dtic Jo tUr [imjim' nf liAninri. (yt tHlaigcd 
gUnj^t, lo lltrimboAiH itni\ oin to bbubivc filcurilJc dlLuion cir mcdiAA 
tinal tumort indufling aiieurboi. Siniibu CUKftViU accouoc for local 
cttcmAA of ihe lower exUecnitKS, 

ASCITES, "lluid in tbe pcrJtoned cmvity niftj be pan of n pencnl 
ijrop^ u in liAMt <ti»cfutc> Ftr]0t|'» dJitoj^r or ohrnniciitv ijulntunajy 
OorxlEUnnH mch u rmFthy«rnu and fibrairl \\ing, or U may rr«uU from 
acj ianti i>r rliRiiuc prriioDitis. whether ■simple. tubercukiuK or Jtic lo 
cumon. mali^&nt or ^henriie^ Fuithcrmore. it inaj be cau«od by 
portal obttruction, whether due to duic^A^ of the h\xr itseJf- as m eir- 
rhoi£». or Lii tliroihlHMin^ir [ircHiurc- In [ubrKu1i«t>, uiuIij^ianKliicue 
OAd moAt of th« mm aftaodaivd uilh new unii^ihN the rffumon U Tela- 
lively «niaUs Occurring as apart of funeral dmja>'orpi.>ndlul)8trMc^nn. 
the exudate i» ultinalely large and produceaatenw protuberant abdomen 
vhUh tffvis Uf hriHuifn in ikf fUnkf i} tk^ patiftit asKumf^ n il^mal 
ncvrnlsnit poiiiion. Tht ttm^ititui tj frominfnt. ptrtinii^rt rnv^h 
« duhfii defitnrkni vfrstt graviSy, ^nd Mtn<* jhtftiHt^ as ike ^fljilicti 
ct tkr fititirni u i/nmeat. Tbc lluid sccki the iiioai dctieniJcuL jxirtiotlp 
Ihv irttestinet iloat upward and jietd a lympoxiiiic no1«. thifAnf^tXiuHj 
^ i^jri tht duinrii hut hrittg dianfiriftiHy e^porttr id faiititm The 
patient bem? en a aittinfl or Mandinjc pMii^rc a ^ucin.\l\oH tortf ia fdl 
If tfaa abdom«n fn iharply lapprd upnn onf* flid^ Jusl below ihf Eiiw of 
pCKBm'on dalncsi. while the ftngcrltp» i>f the (rthcr band afc placed 
opposite- The ulnar lurfaci ol the hand of an oaaiiitani «hnu]d be 

TBS orrvAiP oioHB or disease. 


^mUf viqilkcl fn the nwdliui line between the pcr^iunJnic ind fVceMiiK 
fto^cn tn tntcfTU|il a Ubir vibnuiun tji th« null nthrrwiac indi*iJn)[uiAh- 
alite Irnm thr fnir xvilic w>tr Shif^in||; iTtilrij^n mny Ix' inriTfrrrr! 
tridl bf atHHTVons tthidi prcixcl the Sow of tLr i-iudatr or liold inlcstinal 
j^bin » findtvlAtion to lh« vnll; morrov^. •□nir limi- iruf b? iv^LdrTfl 
■r llic &wd to rluaiiEc iui tiic. ^nJ k^«iiiI monwnu thuuld be Allijwcd 
to aUfae bclore nc|piljr« lindiii{pi src nrported, Such cffuskm nukei 
palpBtinn of tlr hiJn-n. ISht't umJcrljinfEluiiKintdlfl^ajlE ajkI ih-niftnd» 
diat the poJpatin^c tin^yt ttl^^ill lie tuddcmly dtprcasrd. prcfi-rahl^' both 
'luting bnftl tnsjiiniirm im) ii the irnfl of f^rreil r(|dratif>n, Xhf ttm- 
ponry dsplaitincnt oF iJk underixing fluid samttimct mikinjc th« 

The kmtt «lkwf pwIJoc l» otcvanfr fur ihc ddcdlifn <if mull cxud&i a 
Ihc dialne» ihoi ftppeuiit|c b the Yct> rrpon urd^ftaii^ tnott reaonani. 
In ouMiTC tSwAotu wllh cxccwrtf tmafun tbtr wirilic UiriU or watt 
imjr be AnI rartty is febsenL 

Hie fUhoniir Uhlis of dtflermiiA] dini^iHUi tnm to tlif- author 
■Inutti fuEile. Motsblc tfcrcuANun ili4nc« In ihc ftAiik» iml t&icnit 
iIuImm with C«n(ral nvMUinrc at <^nc« rul«« <iut prt^man^y anti ^n- 
ODtflC. mnrmm or A>\/dCiJ cyiff. lltc aii^is brirtv ilhiEiirlrii-alZy uppiuJIc^ I 
Knqwitd a*dl«s cujr give riM to insuperable dinj^catic ftifiLcu]tic& 
UHtmtm. Ir evcesu^'e lympanitr* }idds n univrnEpny lympanftk 
Do«(- Ttic ucilcs of forul ohtlnictiiin. utuAllr due to hcfiAin drrboais, 
^ O gd> b^ ^^If- ihouffFi IT) kny ntjtujLr uivumuljiiinn x lariablr drgrrr 
^^HBtdcim any be pntati in the lonhcr ctLn'fiiiErra. Sudi an av^iUa 
HWbout SHi'i^ «dema ca-vxulii frvtiuenlly wjth umaclulion. pvinj; 
rbe M the <hkt Utrm of "jioubefl rjtg l^ly." A bij; IxJly In m ihin 

ChumctfT of AMhlc Fluid.— It ii utimlly dear, itinv <ioloivd, of 
km 0|>ocific cnvity CioioioiA n ilbumiaaii* Juid mAy i\AmXaiianiily 
oM0ihle. Thd color U Mtightly dArfccr in (-irrho^is Ihan in Iho ordiniiy 
vecoodur foniSL In lubcrmloaie and nuJignanC diseue it mny he 
hemorHiij^'c And laitl^- it is milky nr lurbid Frofn f»t eit true chyle. 
Tlv («! Utier mndilu-ni arr midily dutineriithcd hy the liu 'if ihr 
Itl i^obule* iHiidi in d&ylr rrsraaliLc t da««l)r |»deocl Add of oaccl u 
tfatiwQ on inic>Dcco{>Jc cumlrkaiikin- Uere bkxiing of iho thoivic 
ihiil OMf vr oiay rM i»use c^ylau» uutcs; ni^tjic mtty occur or fiiarlrL 
witfpikufl iMiniBk* b» prrtifiL 

* Ak luh raar* Ahnn«l tsnaHAhlv nerd (ii t# iJi]jpcd the auuvsmrp U of 
&li|-hi pnctkal vM' 


Source* flf 
rrruf , 





lf£l>lCAl MAOMMtt. 

4r tkiii 




SUBClTTATf SOUS EHPHYSCUA.—Atidf from nuliBRGuilvdecu 
utd gbmdcn ihb ocmiUtiDti inditatn ihr catuno? of lir bto ih(^ sub- 
cutanecFUE tueue livough woundjng or rupture of ui air contain^g 
Tistas. M tn ir>nhcatfim>\ cnu^h. ruprurr ai jiuimrmnty Rivrnll. m^Ifg- 
DAZiCulcentioiLof tbce«opliik£os«clc- J I off cfi no dinicuity ia diAc^tMi* 
b«ntue of th« paihopio&uinic nrpEiHtifin of th« iIMpnilpd iii«u« uiukr 
Goger pnoMTt. 

SDBCUTA0EOUS HEUOtlRHAG£S.-lbae «ilJ be folij coa< 
iMcrcil under piujiun. uic] ii need onJ^ 1)c uld that che ili^ctiluntion 
of th« dTu«ed blooil is penUtcnt ujidor pitaturv, that tb« ifk^Is viiidcr9> 
\ht mnt dun^ in mkir ki wi [>ntinary bruiw. inr not H^vat^ ud 
Tar7 grcAtlr rr sifc. 'I1ic terra (cclivinova coxtn thr ordinorr pctccbM 
in the Kmallttit ^YV^ Wlun complk'^ljng an cianlhem afl in mcAlfai 
Of umI^mui, ihty invuixbij icdiuilc a iicvcic type of dlicojC- la 
dLToaic diMSJci ihey an ordinnhJf atfooaicd viib a <UfinHff CHcticafft 
ot n hemiiithagk tendency, (arc puqran. pagL- 4Ta}- In crrluDobscivp 
infcciion» ihcf point to sepau &ad if cndookrdkl munnun nn prcJCfit 
to •epiic FFidocarTlitit. Thty ihoutcl nr>E be coEifuK<l with the ncdilhr 
awrltinx uf i^}'tli'iiin nirfki«uiii, 

l3iiDmbati$ uf (be iwdiil tdiu may pnxlLicc! d veiy mviH and cvlifmt 
cnlorsemect of tho mpcrticuU abilomiaiiJ Teiiu^ and a HimUar condiiioa 
Accun in thmmbosis of tb« Inferior vena amL Thr f^imwr chiefly alTrcU 
ibc median ncipon of ibc abdomen; the rcUtion of iu vcinv to iIjc sa^tl 
suggfttiag the l«rrn "caput mtduaiP/' anf! tfcou^ Ihe lown thoracic 
vrin* nre inv^dved the whole grtmp lies ckiefly wttbin lines dmppri) 
from Q\c middle of iht clavicle to the gr^in^ la Ihc lacier ibc enlarge' 
wrM is prriinm inanly tcuciikl and uiuolly Inu rmmpliralfd In patrem 
tFnionunaTclr, adniUture of tbe iwo may oct-ur as in the aac of a 
nUBiv« aidlai of drrhoUi producing cai^ obctrucilon leading <o 
enUrpmcnl of bo^ gr^upo. If d^e viXm ore cnnipcTeni the dtrecilon 
of htood floTV U «utly d(?tcniiinvd bj- airoking tt« blood from a vdn tnil 
insLing rnmpirrulnn In any fnnd of Intnt'ihnrarlr lumor. nfUcJftU^ 
those of the mediaatinunD. vlalblc ealar^ncnl of the intemal mammMj 
aod intercofial vrioa may bf rrfdoit if the big Irunka are ocanpitned, 
ObUtentim of IhcdtaccndinjeaorUat the duehu niteriovua u a ^Ifnical 
ciirMly* the child uduUy bat not alwnyi ahoT^Ajt a oolhiicnd arterial 
eirrulaiion bMwom tlic auixlavbo above and the vrawls of ll>r \atrtr 
extremity. Tbe vbonocont bnnchings, uicficating l^hc liitLphrajcmiiic 
atlsdiment fmjijentljr obacrved on lh« waJb of tbe cheat, acein to be 


withoitt dcfiAtte cfi&ical tigp-iStcantt. The Auihof i obttntdfiO iVDOld 
Iftdkvie ihkl ihtrf &n tnri«i fnqumilt ob«rrvr<l in tKtm Acnrihig 
otwmaclpd puhnotiwy oPCiilatioo ot thcchrooic type, in chronic ccusjh. 
Mid not tttepuDllj- in connrctim wilh ^nm] Brtcrul or mfo- 
CftnU deictierftlion, Vci thtf may ctijt in (be normal infStiduiL 

PRUG ERUPTIOBS,— A!liiouflh the varioiu cvuithom will btunt- 
ridemi im<la the rrlAOed tliwaw*. the question of <lnif CRiptioo crrda 
Mpuftlc diaouHiion. Th> iodides may produce aoiC'Uke or trrf variali- 
itam or OTthematoux raaha. Ihe brcmidn an afnf 'Ukr miption, whi)r 
phcotcclin vid lis oottgrocT^ ihc boUuns Uvch u copALba), vod^um 
itlkyblt^ diphibem-#ntitatin and vanovi otfier nrni sr opAbkol 
lUudmiLiK wthariii or Rkha tlic iiiuec ejuiilly Buuulutfu^ pciLcbLina 
oc nrmiltL W fever "lo;^ 6^ inimiiimt. Hundreds of drugt produce 
iwUks In mtain tnrlJviifiLah ni^'i Ihe»e efllore M Tenc w are of fa variett a 
cutun w in prcdcirk Urther dcxripUon.* 

DESQUAHATIOHS^-Thc chH Aitaaet followed by dnquina- 
lion «!«-.— 'Kaikt fcv<T n«nicll«), mcxAlo <bniQ-like ic&Im). unallpo^ 
(cnMtt}, erjivpdM (Oalua). dcncaiitu (urnliation). 

flCiUt&--*tSMy Hu iMfvry 0/ itwi^ The pam of inuiLlpnt rTU> 
c«d«dc lb«t dfirair a ibe oue of 11 dcubcful eionlhcnL The «cftr 
of a Cftrbonde at the barfc of the nedr mny tu^Kui |[lycnauria. niLjtitple 
Inmm scm at Ibc afiKlc» uf the inoulb tooceuilAl >xpbilia' Linear 
icui on ihe M hacid uraallf Indicate tigbl-bandedncw and vice t«iM. 
On ibe cbcK soal bright ahimng aligbtlr dcpnsoed acarx may IndJulc 
the pwi ve of croSon oiL aad itTOVped. finelr linear poralLcI acan 
OTvr tb» hingt, Ihrrr. heatf nr Kpleoi m/yensr cup^tije tVit the relief 
ofaoeacpAiaoeaeuectftlUmmaiiQA- SctLr3» the waist LJrc ircconunco 
in llwae «bo have worti ele'Vrir beJis Hwse in (he supn>3rbita] rvf^or 
cff iborack aoncs nmy »JgE^ lupucprbiul or pectoral /^aier Tlie 
fMj dtpfMMd tcar$ 0i acne affect the cb«t. ihouldcn or face and more 
famntHy dfallfbutcd tua^at tvphili». TlicQe over ihe hcct and 
KspoU VOfffM. pan bed aotca and hence paii acvcic nilment;! tucb tkt 
typfadid BoJIef and nab vonmlvt "i^y br- iuggr«rive in rrialion lo 
cbancfeef, pasi oocnpatko *ad prracnt dise^ac^ A acton nuiy hnvc lefl 
lis dotifcle scar oti back of tlw neck of aome mtddSe aged or ekkrfy raan, 
Scan about tbe fleck if bng anil lintoj and partlodtrly If h-fl lidet) 




I ii|iL>ll 



* F^ en fiTi'nTaT 'hmiftf'^i^ i^ topic MvAUbwri Srinicmnf Mrrlkinr 
tin a ckrkal apfcarv^ paliiail from a ndfthboriniE tULf »ai:h u vtoucd 
li> Laic Wn the rnaJl of a drunkrn brairl in a kiiJf Ihpuv; aad 
BO an inTcaticAiHA of put and pR*«t hal^tatbai prcnrd illutninatin^, 


mmcAL D1AOX0U&. 


( huif nHd 


la Offl|ln hnd trwferwt suioecsi lujIi^klAl Altr--(npi& Thry usuAlly ran 
(iownward lrr>m ihc 0D|^r of Klu' j^w. Puciecrrd, ■lc)>rTHol, JOfguJv 
warn in ihi.' i:«rtii:il rrkiGglt^i^ f^|>T:>cidlly ihr aniedor, *iu^;gncr the ilow 
b«4lio£ of brok<a down tuberculous glvids^ Scua endvnity due Bo 
niTi^CAl opcnLirant unuiUy iitdlcau by their pouiion ktiA cxtcci the 
n«turu iif the opcratlun md ii» probeblr cauw. SL^n In tlic KiuJit 
rin n^'J aum^'sl past lyphilia. btjT raHht-r rhuncivn!. IrttU-ivl ihorr i« 
nol mavh nf pontivp ili/lrimtiat or dm^iontk' valui: in iiyjihililjr Kan 
avcmtertainnluatiaiuorinferUicCoiiiuof th« cnipiHin. Infccitn] 
one may M,y thtl typhllftk icuit mAV he round rvniform. oval nr 
hvrsnliiicshApcdi loiiwitl) And svldorii lr»ivr»c4 by tibiuu* liui^ 
VJDCtspi At joinU Lupui m»y cJcHM-ly kimuUic nyphirUfi but i« nul moiti- 
fomt- Frajurntly therr ur muliiplt puiicLattr ikpn^^uniti and tumt 
4iU luetic Man are ptioble tad hav« a hTOfmbh rrci tinxJ&- {Utt alto 
cypbfib-) or iqicdnl «[jtnil!cAn(V nre ihr Man indiraiing a primuy 
lc»ion, ufludly, or <our»et upnn the fffuilnl^, and tlwac of a dcnmaivr 
tjkfraiinn of thf ».-jf\ jmi^tc. Tht tear 'if »fH>rfLlion foi epiih«lioRtH 
tif ihc lijH iir nine is esjircuilly suggralivi- I*lui?ili inarlL) frum olU 
fiDCfilc coated wtlli aiddc of Ifon mny njj^^i continnvd morpihiniiea «ir 
mniin km 

THE HEAD.— Open HtiturT» pfwiillnic *ficf thccrfh nncnih »u|»k<:IiI 
hyflnxvphnliu. crttiniftm t^r rirlt^tt; thi' piAffrurr rriniAnHir Khould Le 
di>»e(l n( the end of th: second mucth. Uic antrritir at tlic cud uf Ibc 
secDod yeAr; delayed elo*ar« or unusual tiae mggvtU heredJUiy cyplutii, 
ncLeiii. mmI lEriiniAm. Rtit^Inic fonUinclIeA ociur in chnmk hydro- 
cei^afua, mmlnKrol UcmorrltHK^ or bdnnimntiKii^ filij^ht profninrofc 
And piil^Tion in^y nixiir in any rhild uifTrrinft from f4*hnti> :<llmrnt4 
and b ncslisibk, A makcn fonluidlc is prcocnl in wulin^ dJKaac 
wid spdhovs hydlirH.-ephBlu*. 

Craiilo-Tabes U indlc-aidl by a »ft cncUe piodiMeil tgr 

over drL^'imt<Tibed artas of the co^nUI «r po^Hfer (wvim' of 4i^ 

parfrtal Imnra &nd ln<l|['sur> lirkrt^ or HTphLlls, Tkf pmitafiH£ om- 

g€ikM iumtfrs of variable tizr but^^rK frtim the sutures &rr dtfrificd 

IS hydreno^phaloccif, mFnin^crlp or enceph»lo«le. Wmt at Gyttf 

«ic ccmruoA m the veAlp anrl ihouid nol he conioM^ with ihc deeper 

mttiod (mmovAblv cyphilitk noda representing a pummiLloui pr^riciiiidfi; 

I oo-Tiifrling bmln Rjinjitcifi^ suocoil slmilnr KRi«iIi.> on ihc iricirrMJi- 

I fftcv. their ronustcnee i* «nft nnd douichy and there nm ntictuinid 

I e:ueerbi.tJoiu of the |nin. 

RLckeU* — A dAilencd beod with rbacftlcd verier high* squint 

TSB otrvwjuuft atcira <a itt»ufE. 


4fkn bocililjr proloGtingr foxehcwl Arnnounli&R a tnull! Iwe iftdl- 
CAMS rSckvu and U unally >«»ci4l«4l frith ffvliyrd ciMur* of il)« 
foaiaarfke. a awmliDg focdiratl. niij»u1dj ntcaLnrsL b^iksvanliitst, 
Mttffi CTDvtlu bcftdinft of tbc ccisto chondml articiilationa ("riclccty 
roMfj") csprdfelfy Ibe jih and 4ih. qilphy«rd nrdUngt uid a potpiihlc 
tbtltnlAjE «' l>>c po«4cn>-bFGrior wpcct of tbc f»rid«] i^nd occijilul 
boMt (crtA>o-ubc«)^ DrffVTnldM oT llw chnu tcg» find vpint &re 
aikI the rcBtlcn little alccpcr nu/ tuiTC rubbcc^ away the hiur 

BjdiiKcphalttN. — If llic duld'» liEnd hr Urgp but ^IniEai ralhcr 
iIma «quarc> tke kft nlatwdy «indl, the ipacc beitwccn the cycbTowA 
ptntBinmt. the fnniaTiHIr hulufnjE. the kueiiets vpnrciird and ihc 
CXtmal veuu rbiblv JutcndciJ a hiAtory <d cxcc-oirc crarial ftwih 
Cr ccRi^iroriil dHormity will b« ubtiin«<t ai^d hjdnxe|>hjJj« la tvidmt, 
Osteitu Defcmuat.^A tnatked incttttjc of the bead drdunfer- 
CMC wi1^»iit facial ioiiireibcfll ffiay b« uuxulcd Willi \hc ewvaUtft 
nf the vdofffd ihafu uf ihc \\«\^ ^h^clh 4>ianui«Tf]ElntC ihi- dUc^u. 
Leof)tiUi> Ofsca- -Frequcndr pm'luccs morkr^t dcfomvly of tbc 
^ skuU, puiiciilkHy in tl>f frtmtal rrj^Lin!!, by calt^opbyik cft*pastL 
I FftdAl Haniatrophj, — Sliglil uniSalcnJ diilnciicca may caiutituic 

I ik|vc<iemitv vtijcinata but in tnir hemiatrophy the fa<c i«me<jaf]y 
L ^viiird Uio dbiliiuKly dUTcrcrii haiii^ ihe rximne uiil apfhuenl 
^^fcafintion M the aao *idir cuntniAtiniE sharply niih thr bvitirr nouri«h- 

r THE EYELIDS* -/Ml ctn^ fr 4f»5ib'it>£]j m^jf marked b bm- 
ilcae* are coounon mdldiicci r>i iccnsinia) didtirbvice or pelvic dicccuK- 
In both ac3ut and ai any age :hcy iiuy indicalc c^iau>tli» from fnln, 
in»maia_ over tawnlon. weak hf art and uhauwlnfi dUeuea. i^giWM 
m jw e OM wf of the 1UU may Sndf-.^i»- Hrl^t'sdi^eaM, areeDifsl iKiteoning, 
«n«niAa or poluasu. VnlUlenJ ffweUirg may be due to nngu> nffurolk 
fckma or iflna] inflaniiration*, cuo^h at boiK t-rpiprlaa or flnnden 
UoAbUnd airdlJag vrjth ranphthalioor* may indkate teitbral ihrtini- 
bMii or tumor pmnue- Indammalic^ ol the bd* tbemuKoi may 
le odnJwiUnitia. aim pic w hjrciiTi^. a;id !» a lviultiui^ maajfi;ala(iuii 
RMolv*. coryca, uodmi. bay Eovr and rynirain. Styra, chalaaion. 
vpUwlioouioua or typhilStic ulrm^ W^^Y tophi, lacrymal rysl 
or obAlradBMi nnd blqiharitift marginalit may bt evidtcit btit n«d 
nrt dleniVd dKeriprinn 

THB BTB8< MaC) •ahial'leinfertnccamayfK drav^n (riim (fircfd 
ln«p«ctkm of tte v^ and ch« erppivsdoa mny indicate bml habits con- 

cur i^ 



icCDiCAl riAOirofiiS. 


In via]. 

Of liule 

Undf ivrjil . 

onled. and oDen givn i dm? ic ihc vholf rnnprrrtinaii And diipodrion 
ol the puitnl. Thf: tuthof hu been opecklljr inicictlcd in the studv 
of ihff <]ro« oi the tnuiw, or thoM of {nttnt hmdiiAjy prcititJpOfUTkm. 
Studjr uf the bftckgrountl it oF counc 9. mailer fur ajjciuj in«cMj|^- 
lioii (mop-55tV PwtJjmsof Ibe ocular musdceutndiiC^ed by ptcoia 
or «inbiuniui ai oore mggoitt sypkUu. tiraln timon. locDnKHor AUixi*. 
<vrc!»m] henaoTrhjct^ or In icok di«ca*ciy mcaibc'tu or profound 
todevmli (wy «lao p, jAo) 

Ilrslftffmufl 19 «a involuaui^ Itttcrvl, loUtoiy or vertical movtracni 
nf thr «7rb&U. and ii C^ isAjirfCM ef ftxVrVW rfjrorSht trrtm vugROli 
diuoninaEn] iLlrrcoji. rurruits of the ocfcbdhim or pons. Icuumutor 
atula* or mow mrcl^ FricdrefclL'i ataxia or epilepsy. 

The Arciu Safii1l<t.'ThU In a nympiom of Ifnlf vlfcnWnuire vhen 
s:^ in pcmMu beyond middle ajEc u il i» merely a local iftdicaiioa of 
the gPDpral dvgenenUfvc procnn; in youoqcr ptiw it ii ^f muirh mort 
vgni6c4Ui(c and may be iuoodatcd with aymptomft of gcnccal vAotukt 
ciiani;cs. It u indjcatcd by a vbite lice furtwindm^ vboUy or ic 
pBiT thf enmpal mATgfn 

Bxophthalmoe.— Tn m<»l c:a»c3 thia ib bilateral aad aaaociatcii with 
enophthalmic f^rtre. boih ryvt bttni; unrluly pmrnin^nl and produdrg 
a pcciLli4:ir nlorinH citiirtHbon. Kinking lad eaulv rcixiisiniicd. Unilaten] 
eiophih^lmot uAually iadicnttb a f^wtb or lumor al fame kind io doM 
reJaiinn m tlir Hffecir*] eye 

Enophtbalmos. -Thia 'a the oppoute of exophibdmoa and ordis- 
arily aceonipafiH-4 wain'n^ ditenwrs, §^vt-rr 
hcmonhflice Qf pr^Fuac riijiirhtcaa. Umlatcr- 
ally i\ ifi found in hemiicnophy or Ecuoiu ot 
tlie ^laijMLliriit utusiii/ iu^aiiliilii»n< 

Cornoal OpacltiM.~~nic*£ indi^nic At .i 
rule lyphilia or a tubemiluui (rmlnu-y bm 
they may mtUt from injunci of any naiun. 

Cataract.— In many run this rliscisr cf 
Uic ciyiuUJJic lens MtTM to reflcii a genenil 
d«g!in«ral^« protaii. and should cue^cst a 
^inatakiaf^ lnvt^itigalioii of the hirait. blmx) 
vc»eb and kidarr^^ Junnile cataract is 
fmnicnthr aaMciaied wirh ittnmia or coo* „^ ., ._. ^ , _ ,__ 

gcitolal *Tphili>. 

Tba Dr^r and Moi«1 Eye.— Tf the eye be prtmanenily or fur len^ 
vamn/M by ttit Uda. it beroiiMs ^tuKil and dsy u abo in piofomid 

IHE cnrrvAvP sighs of i>rsEASK. 


hi til* ochcr htofl cxccttivc ladirymAtion may £rccnn|wif 
inlGMioo ol th» coo{uncttvA or phoiophohfA antl aciluI ok'crAow be 
pmcDt tC like Iftdnrout duct b blocked or -lispl&ct-l (rpiptunni}. 

THE TI08E, — SmMIc tumt is rlisniJSFi] dwh^Tf : » <catk: hntftd 
ortui ia KCQ m ccruin slromous type*, and in crctinUm. or mar be 
fxmiT ncul- lu base may be brxMd xad ihApeba tn A^draotd disnsr 
4nd TiJiul pJfpl And it idajp b« the ml of dlsircMing vutuIaHl}- circa 
in tho lcinp««ic individual. Such innoccitl ndncM is fatal frrquenily 
diw to npcuurt Id ihp Hrmrnti. gntfric and pcLvfc dhlurb&ikm or 
c^iwpC obdnnictive ruuHl cnUrrh. The aIe may any the tuberculoua 
or epitht|H»i4iDua ulcer. 

Sntczlag noctia nu $pniBl diaciUMun thuui^b ocutawaally • tmiible- 
•emt phvfioiiwnoD-* 

WoridDg AlB>*-tn rwjracji' hi^ &tntng mdmduals Th n Sa cnniiionljr 
olwerTcd vid il aba eoiudluMs one o( the sif^ru of d53pn<f&- 

THB EAR.— E«rachf.--lit InfanU the onndtlioTi may be bdie&led 
oolj by CTjht^ nailcas mavcmcnl of ihc bead of nibbing the car. 

tbttn aa in proloucdiy toutmie aiIuJAb (typhoid, etc.) an ami* ' ^"^*^ 
hr oiiiis meftM mav be entiitly orcrlnnkpd iinii! the JU- 
duff^ oppeaia. Tlic eondilicm b a crtnunon one in acute infection* 
(cspedall^ Kaikt fever. iaAuenea. irphofd. dFphthrr^a uid nwat1c«) and 
its CocDptic^iona are so xnovi* fmaatoidiLLi, metim^tu brain abscrSB. 
«t<-) sa 10 ifanaad cMcfiil watcbhig in tuch cuml Eaiacbe may aI*o 
be due lo inpaclod eciuinen. abueM or oriJ^naij furuncle of tbc* 
nmtw CRtemu*, Mnple eatarrhaJ inflaiomalbn and blocking of tbc 
emUKhlui cube, ikravrd letH and al^rvilar ahvr?«. forrlgn hortfeic. 
aeunJ|[ER, flDd rudy can^ef oJ iIk tongue or even innominate aneuriam. 

RnUEOmA Auris,^BniuiQg and iwrlling of th« puina ta fr«* 
qucnlly encooiitcied in tbe inuinc- 

CjUKMif ttod Ajuenna are vrcUbKonnl>ythceilcmalear. Iltiathc 

Of un flvvr- 

fmpvm fkm^aa foe frmi b!tr— and may be thr wit r*f odtTiXKi»i»^ osI.i™h», 
(Uue bitick csftlhien), pcr»*tenl loca£xcd ctni^rne.t fiouiy lophi ' -nai^^, 
Ccrfiry Mcttnaa ttiaM noduln mv (he inar^ of Thr jijium). 

DlMlMircM ol various kinds may be noted. Slight and serous il due 
BO BMAaJ ecxcna. pvniknt if from punitest olttU m^tfia or ine4lai 
nbKCM— ckar and scnnia cc prlnNufly blix>dy in frutiirn at llie 

* Vn coe iiiftanoc kaovti Ut the «iilbor p enii ^ m iiucBai cuiled by 
Morval I f an a] atlvali provrd abtoluicly intiactablc. 

tta a ^aatoC dnis habHiaubn a nrvTveni yytPt of yean ditvniloa 












hue oF ihc ■kuLI-'hcLnnrThAKc (foni the lobe In nul unoimmoD In 
hemophilic tvcn vrf thout wound or «t}nsion. Atr prcMura u in «siiUttr>' 
omciiMLkin itr caissoo dter&M- m&y prcducf htmtirrha^- CSee alto 

utclilory ncivc And tla duMASCiii p> ?t64.) 

THE LIPS- — The g;rL)U|)ecl v»cIm of hvrpa commoi] in CDryu, 

' pjicumcmia, n)Aluri<i1 fcvci; the bilidl lamn \A i^jiIiiJiA or tlic inuunj» 

' jialchn o| tti? mmc thttAae. tpiihfiionut And £«Aurct vc «oinc of Ihc 

ImjfoHHnt ixinrUtl'ins \n ht nc-ivrj. KjurhcUonu uwiAtiy ociun ftl or 

I boyond nidillf a)!t, ordinanJy ofTccU ^ie lower lip. grows mdolwiJy 

iMiifl 0ti*tit for a I^Mig timF lA^ithoui mnrkt-^T involitmpiit of Ehr ntighhoring 

l^andi, Th? loUisH Uii-^n of ^t^i^^ilis h f^t/mptiy fiJlijvirvt by ^^lAndulu 

sffdLtn^. Mucoufc fiAkhet ind ny^UtUuc itt^wKi tttid u< involvt the 

anuk'A u( llii' iiirjulli inrj k-uvc LiTicit ndiiiliuc auita. t>uL urtLnuij 

"cold cnck«'* or fi«ure» mo of oo signifioiocr. Acute >urpUmg «f 

ihc lip* fommnnljr Indlafn imumA, Inirrt bilPH angio-neurotic: edma, 

ALinple abitccu, or m'>rc nuvh lyrrrv^vA piiiAon, cancrum ^riit crrdpclai 

or phE**|[m<'>n. A*idc from pamlynU nr firimurr rrkcnul rtrf«-t* the dij 

Ii|B iiid upcii muuili wt wtii in tunia, Lhiuiiit bypciin>]>Ky ol ilit luuniU 

or a ntual obtlniceioa (luuolly due tn adeands). inflommiiuon of lh« 

hucml rKvli)', ihr pnifoiind mhniiiiTJot^ of ctnjUn iriur julynnfnic 

febrile <MndilK>iis «nr| iHc terminal altfjci^ ol chn^nir discoK. The 

hp* arf pr»ni;iry imliciTor* nl an*mio nn*l cyarixi». 

The Odor of the Breath* ^In ocuLr in^wnin^ ibi* max 3^^^ 
JafonnAikHi of the fir«t imponiJice oixd the odor of carl>dk add. ite 
ftTi^rflallr biEter-jLlnii>n[1 ivlitrof hydrecyanic a^'kl ftnd [h« jicculinT »mct| 
cif etiivr, (hli>rafoniiH lauiUnutn *nd*kohol«rcrc4i|jly liletedcd. In the 
lerniin^l «a|^ ot rlhhHc^ mell^rm ihr fpn^mrf fniity hrc-ath f« m>Hl 
suggcaiive and of ^eriotu iinp<jr|. f^ospbcrviu yields «n unmbukAbk 
odor- Foul brmth in ItKlf mott often indiotTM improper cu^ of tlie 
lectb- iuaili|jfllkin- ihninir. iuurf>-phaTyn|frjil niiAnh or UxmI dlh^te 
of the hucciJ phauynneaJ ur nii>rr <>((rA rhf nAKi-|ihiLr>nx- 'Ihc hnd 
brta.thof clin^nJCflrtnkm E» u«ua!l>' durin rhrvmiirgnMrtlip* A [iriuliAr 
henry, aromatic odor la noticeable in flD-allcd unrmia cr in ihc irnninfll 
■tags o£ fjultng bearl, and a pe^ii^ar cftdnvenc cmiinBtion is tcmdlmM 
noliccAblc at Ihc time iif denth from cihauBtiaf dismct 

THE BUCCAL CAVITY.— 'llw pEf^Dwaltrf frt«tt« of Addboa'fl dift< 
««M- at'l't'^^ 'ic'^ ^ '^'* <^ Uingu«, aa do Jaundfor and t'yanu«te In 
aoitp exnnihcmatous diecasaa it way be th^ site of ?hc earlieal fmiption, ■« 
in meoslea nfa«n* unaU red xpnii with a tiny bluish white eenirr appur 
before the dndopmcnl i>f ihc cuLancoua fmIi (KoplU'* apotal. The 


|«pi]ks uid \TUclo of witcllb and ivii'oU inftv br vrm and the viiid 
wio— < of taikl fever w dufmclensiic- .\& rrjtjmU sccrrti'Mi, there 
mtjr tv r&h^r ttrytifU. wth m oroiTn In motiib hreailKTii tmm whaTrver 
caoM. or nin^'i'Av aurii ia accomjunke ccriain oi th< acuU' infltm- 
milioiit or muln from th« i>v«r*u«P of mrmjir. Kilhrr n>n.1EiScm 
■Mj be A««)cUlcd vith ihc hnt^cal or iteiinb»ltwoic sUlcs, and ihi^ 
drooliaft cucb u <Kxur» in bulbar pobf. fami pftnh-ot. dii>hLh*^ric 
p*nJjfil> uid idiocy Ik cujI ncoevairiLy ACirnilc<l by nctuaJ lncrai»c ia 

STOMATITIS- — 1iii1j«mniH([rm<if Ihtrtiurr^inrmlirHiip niJty ultrlhr 
fbtm of <Ai, Simple CfttArrh ai seen in tnthmc children, icuk mfcc- 
tkws dutflvi ur Of a muJt of gulro JairtlinAl diiiurbiintm .or dirtrl 
liriuiioa- The omdiliitn is chancttrj^cd b) rcilric«9^ dnticjd atid 
beti Oii ibc mucouji luHocc nith incrcAM of SQLi\a, diflcacnfoit upon 
Ukifi^ fond aa<l moiI<"niir frvcf. 

(bf. FolllciilJLr or Apbthou« StommUU* -U an mdoncc of 
|iD[«irr(l pRtcRiJ brahh jittiI Oigr^iion ttm^mon in childrm. noii. mfr^- , 
c|ucfil in jmIuJu. and ia ihftrAiteri/fil by iinfLlI vfni<lc:i*at»n truuforincd ! 
t&lo MiiMrliciil vnilJ ulcen wiil^ an intUmrd are«lak, dtten nppfarlng' 
in mf» Aiiii intutvitie (liir9>' Ibr t:0|ii?i and lliv tip dt ihr laa^iu', iIie i 
ikopcT (dMsi or the inn^ atf|>n:t of Xhn thctka. Const ^tulionEi] svmp- 1 
loni arv Bdmlicil wiitv thoK nf thf ratirrhal form but th^ pnjcraj 
taav be penislcnc or aprtftd and fpvt nx lo a icrcaur deicTrc of pain ' 
and Iniiaiinn. ' 

(c). P«rMiticStomauti».— niir\udi. muKUrt.Kwr.niytorK »loutu*| 
tili»). TliM i« live If? Ih« iHJiufli dJhfiiHj thown iradEly undvr di« 
mkrascufr- li vnuia clUrJIy un^ln cundiliura of poor nuiriiuin incJ 
andeuUj viJ^cik] fce<tiag-in infuiU- and u ch&mrtcn'jcd by «miii[ 
ovd-Ske dqmite a|iprviag Tint upon the ronj^p, but lending to 
cotknec apccud and ctm, la cittcmc taxs, cover the wli«1c aural acid 
plwrynfprAl wriicir, Tlbe j^rchcs are readity nmnvrd and li^vr no 
alcnslkm ur cvnrialctl mifHLr, 'VIk tibjfrvwB itcpindh u[)uii liie 
piiiMj focalkA of iht loBkm** th«ir i^tculiaT mjicriicki nalur? tind the 
UK of the mioiiagcope. 

■cnuri«J SlovutitJa.— KJili<f Ihrou^ occup4iianal pouonlnjc. 
Ubqmctxnr or nvtv doting merrtrry may oiiwe pfofuv lalivatEnn 
aJBvdftlot wCih sponcr ivdlinc and even ulccntkin of llic Ruma or 
Twiy nrtrini of th« ja«, A mi-tillk ut(^ sn4 f«IJd bnnih wiili trnder- 
neu nl Uw kttb are uauoJiy Lhf Tint symploao. and patiput-t under 
TSmutuI Uvalmcut ebould be cuefally mtrh^d for in^mucd Haw of 



■iht ntlni^ 










ttllvft. tod mtde to bring itt lecUi tharply logeiher U tkA vlllt IB 
«fte ^k4l lendcsiKH ai4;r b? detcclcd 

OtflfraitMn Stomatltlft. (^mi«.)— FortiitiAi«ly thit l«mbJ« oil- 
meat i» rvt. being acltlum cncDtmlani save ui [be bull/ nouriihtd and 
cuvironcid cMldrcn of ihc dunu, m whom it follovra «mva]c*ceiKC 
fmmimir fcvrfu chidly me.-uJ«. li U rhimrt rri/rd hy iho Appraranov 
of & slouj:hiT]|t. tprtai^ine ulcer uiuall> on the cheek, nrcly on tht gum^ 
The brvatb lA l«eiil, U]«rr U high l?v«r> prttfound prtwtnlion, ddihum 
adU dumhoa. Gangrene lapidlK dctdopa in the chock and may 
invo^Yc odjatmt «lrLictu»« to a fri({htfuJ dcffrw. ^^r afpcaf in oAhtr 
porlinnii £if ihr hnrfy. The ilJAnur U nlmrm invariahl) (»[al. 

OlficrAtiTe or Fciid Stomatitu.— Ttiia cr'ntfilLcti aliiidA tnMikaT 
b«ewwn Xhv npXtthwa form An<1 nrirnim nri&otL-umng during dentition 
UHioUj^; but midf in tdtiitK. and it timc» seeming lo Em cpldcfluc. 
The i(ums hrc usually rvroUen and apoagy. bleed R*dily uid ihow 
thiru' flou^liinK ulrnntion. The pnioen o(CMlon4lly lnvn^4« iht 
lon^(', ch«cka ixnd InAcj aurfic* <4 U» Up«; 1^ rabmasuUvj glonds 
enlvg« aod the coturinitrwial sympt&aa tn oft«c »er«re tsd usodfttcd 
irllb eMiremg pro^triktkin and moikcd fcbnle rc«i,~t£on. Rarcl>; uid 
chiady in ntanumici children, the |if(Kttt ummn * lyp« luggvtjng 
DCMiU' but ordinarily tv^tisrjy wxun in s wrdt uir ten dAvi. 

THE TONGUE. -In many dinaftn,iicutcordirDnii:, whether o^cct' 
big |>n>xim:iiF or mnore MnicTum the rondftion of iht (j^n^if may aa- 
sifll diajt^oAiA, |'rcgno:iU cuid trratmcac, A UghHy toaied loiijcuc nt&y be 
found in pcni>nft oi perfect heiilth, or rany indfcste tavcr. divttAt of lh« 
iUJK>-pluryn]i. gualii."inii;«tirj^ di»tutbH[ii.»). mere ainuliLng. drinking, 
or the pQimnrinn of bad %w\K A knivy patty ytH^i^ teahrtg in tiaucdly 
IndlcMhe ci otUiiTlud gosuilix ruu-ph^iryngi:^ narrli or Himr dli' 
luibancrt of the digestive tnucL A cUnn hngttt may be wid often :s 
■ttodatMl witb picric hyperaddtiy or ewa tdcer. In chrwtU dyr- 
pepsics ibe tongue b jWAy, o/ten a>lorf«l md hknUy imjenkd by 
tJu i«JA; ia the lyphnid i^/V tk4 kt^svUy <cotc4 kmgue a ordiouily 
hright red AkTi£ its nidii^n uid al lu tipu tvhicb ofirniimesL &hnwft a 
triuigulu' red Ann. U aII condiliont of pujowfd texttma and AurAait/- 
Hm it l«nda tio brCDme hnrwm. dfy and /SuvtaI. i« iftrmaJaut. ibnfy 
pnktided omJ rcfrtidaJ 4nu/y or ofJy when onlcred. Sucb « tongue 
and its confer. I he ftd. iitiny. dty. '* twjy" loEigue indicAle« a bad 
prognrkHis. The sj-called firj^Arrry Am^v^ ii frrqucndy K«n tarly 
a &n aiuok of iou'lel fever. lu name h derived from iu bright red 
«Ujface-point9 dnr fn ^nrnllev p«pnbe emphudnvl by a while ptMy 

mx oimvAKD «tcNX or nrausR. 




b4dcgintt<L A mOalmdi cmB$^ auggcsta hcmip^exii- but may bal 

duo to twi teetfa on the HifTr^t^it ■iMr. Ow^ ;&i5ri/^i ilrmg U>« vdge in.«j,i. 

fluggart put wyfk^s; h rtdcOs the scncnl pilior f^r aiiarmia ajid i£g 

cjrncow of c»rd>K or pultDOOuy ducAse, and on« mi}' di'i«c( a tubcr^ 

culoti* or cplUidiomfttoUi dceriikiQ ur m:ui» w^i^tivr ol the rcn^r g^^^ 

bfcin^ of tpUqitic B>i«im «r ^OMO-bbirvpta 11:711^ a] jmniljiLt, Vni' 

Ulffiof «»vfkA>. tlie ftviwr &nit ;<t*> prffirusitm of marked nl<i>holkn) TTfmQr»Bd 

Off advd drtihum iJtmena and t»u»tj« »puni, a»i>dale<l sIlIi psuTsu "■'^'■f' 

Rum Dot be fofgotim. ^attai emiat^fniais mA> br due lo ftctjl« 

gloniltt or to aiCTOmcifnly and mjrxccdcitu- V'iM«or« muat be ibijuxhi 

of SI vi«U u ;li« vthoua acute condiiionji alF«ctlt^g tbc mooout membrane 

ol tbe moyUL Variuui ^fncnl dcpttih tnaj ou-nir h^m u in oihrr 

pMliocd of the or%l niocoiu racmbranv* Lbr mo»L marlicil a^c the deep 

bto«iu puipte or blick depodU of Addbnn'n dtMwv, ajid ih» yrllow 

IidC of iht u»dcr snrfiuc In jauDdkc. A ^ck hnguc uHiallv indiaiea 

tlie W* of iron, biamuth at charcnal, ihr brmtn 4isc^i>fatums afe , '""*"* 

mool OKBiDOQlr <luc 1o ibc uM ol tubfli-xo, liiiuoiiee ot rJtixnbitr. Ii^-m 

often to h"**"""" tad rbubarii. The tDrToAivc acidt eiltiei wbticn 

ibe luriur (onJJc oiHnlk-. sulphuric add* ai wr-il at ainmoiifa ukI 

corroetrc mblfmate} of /cUow H ai do ditonuc. hydfodibrit^andDlDic 

adds. whilmutlfr«'vlit AT pntath and thr nlTni«of mercury red4ealt. 

[t ma/ be (Ik aiHinx ot pcoulntf bvmoTTbigt io piupunorbcmopItEtU, 

The vera "jEeofnpluc leagiw" i* applied lo the annul«r red pauhea 

dor lo eoctVA. v^Hth rpttad pcriplienJl]! to fnnn rnvniric aivMn. 

LnwofilAkiJi BuCtfftlifi.— (Buccal p9>rui«L8L Teueoirm, idiEbp^si*}. Is 
chumdcrised by tno iilrrmtivt- and (nrgiilat tniooth. nhitt. firm 
rajKd paJcbtt. The sm^ki^i pokk o«upH« the dL>nal vurfMV of 
lh« tip at a peuiy fdk>uv cr pertiipc rrddiih pEaque- 

TIm GtiiU4--*Maj|;iDal rrdocu is lUUallf cf little ihiKtiirrtitrKr. bvinfi; \ 
ittribiaiabk to tineJcttAtineaE, and deatal airie*. ihuui^h it ia thought ; 
10 h»e mmc vgniAtwicr in yi>king i>crtant u ui ifulli^iiinn uf [ubenni- 
loibnod ii prevent Dn several <tflh«cacb«ticauue. \ emyiih cr hiulsh 
gr^j or btaiJt fw TnAv [n'Lcnle iMid poJtooing bui ttu* line ia Miher a 
tiom Acrira uf dots and Uoei about one mm. (icm the actual luargiii. 
CthoX iwlty proiHls againM tlw u«e of the term *'btue Unt" in lh«ie 
cuo. More mrdj n aJmiliu frcent'A £/«e 'iw ti pfoenE fmm ci>ppeT 
poboobg. SuvitrM, '^MiTT ^ hiftidtttx xatm$ an prtacnt moat eom- 
mordy ia nurvvrit] fiofniiiiB nivl rottdlliixa of gn^iit debilry anrt 
exbauȣioD- la acurvy il conaiitutco one of the promlneni aympuims 
■nd id pmcni oCi«ntiiii«a m iii« various cKhexIai- In nej;[ected 





■f the typhoid tjrpe accmmdfclioo of ormi dcbm frarn the lo-called wrifir* 
tim*] hbscMUft asd vftrioui growiht met ni ppiiliB rnay iIki nnrur 
in liiii rtfjioQ, Around lljc base of iIil- M;uinb m veil a« in tlic more 
Radilj risible f*'^*^^''' ^' ^^ buccal mucous mvmbniw m^y b« mn 

The Teeth. -M rcearik iht penod of cnipEiOD of Ih? fint and 
s^Dond ifiK ai in^ih, n vMc mnrgin muxr be iilLou^rd in tit^ih dirfctioi^x. 
lA unuau^ly c»rl> appcuwnce being of no alcnificsi^cc iihile a gncUy 
dc>lay*d vTupl^on fa uaually indicative fd malnutrition and <ifini Aocv 
daud willi dblind JcrrlopmcnUL Ocfccta. Tlic dialurbaucn cd dcnt^ 
tHQ i^iiLe doublU^sa TXiggvratM are nrrtrliidt'afi im]x>itanc and an* 
■canintaljle im nuuiy aUmi^iiis of infancy. Any doulHing phpldatt 
would be convinced of thii foci if he kjinucH sibould far n tlmc^ suffer 
ftom ilmJlar ln£ainmaiJi>n4 fn^n whnirvtr ciuiv On ih( other hand 
ho abould nol loo icadil^ ailu|il iJic dblurbancc of dcitltltott aa ft cdutcr 
«d diaHBff Imi hr L^n^rtx^k morv ronrrvt* and icrioiu oondirfrm^ * 

Hatdiiuoman Toethn— Thoc Ta.-ili, cIiarBaniiik of ci>i]^iiilal 

ayphnk. nix often mure bi \ta^ clo»Jy limirlaleii and a [roiitivc dJaflinoaia 

itioiikl br mo'k i^nly vhr<n they prrsicni ihi' fi>llrfAiln[:p t^'piri! chnnri«i^ 

odea;— 'In the acoond dentil iunt pqi-likc, roun'lcJ. itppcr ccniral 

mcuora uitually dlacolorvf. rmguliriy plaiv^X ■■paratrd amcl b«ariftg > 

un^ vrcU defined nuUEi ai their cattJnK cdffe or crtn kaa dinncicristic 

Moth nuy b« termtd nphililic If auociolrd wilb a hisftoiy of middle 

tax diaeue. haratElts, i^rr btitiom, and ti^Auroi or realdbal linear mmfi* 

at the anjtica of ific m»uth^ Transverse jcroovca or fttmrns lilic thoer 

of <hr naii« inHiraL« pan trr^rr iiln^n dentatr^l cuiiirig niArgin^ arp 

ODiTkroiui In malaulrilioci and pitud iccUi nwy Ix due: to AtoniAtitiL 

£iriy decay U oommon in pregnan^-. phoiphorous [Hiuoniiig. ricLris^ 

d^^ff and other forma of were iiu-luiimtltin aitcl the iii^[«iitjin(e 

of i^ood t^th in ennnoction vith din>ftiG dyapcpnia ia loci little appn- 

dalrd by the Einciiiinnrr. Mary f>b»iin&ic aftd |wni)iriii flilnir^nia 

«re pTooiptty rured by proper alltstioo to the nBkainin(> Icith. the um 

tS deolal bridge*, or «xlra(iion and the ttubatitutkn of properly fitting 


•Thurtuiaal prnoiUan«Sn montlut— fir*l J><t*'W«.'— two [qw<t cvairal 
hncUon 0-0. KoU' upptf inciun K-ii, KovJf ftnirr^o' moUn i^d Lovtr 
Uitrai intiwn i»-Jj- Caninn »S-34. J'ffcicnfir mt^in 94-jo tin all 

third wi I7^<. incfn* J T-^ Hkufi-Js q-to. Caniim is-m. Il f<il' 
hm that at ue end of the Ant tcv (Iicit *tv 6 Lfrthi ai Ihc <nd of the 
•ccond l4w and thai the finn denUtkA ihaidd be ojiaplctcd in two and one- 
half y^us. 



Teetli crlDiliMf ii a conunon qrmplom of icSex itrUtlign or fGM<ric 
ditfiifb«nrc ia childrea *nd it rbivlj due lo the conmonlf KMpUd 

The Jaw*. -Tlic hi^h ucbcd paklc 90 commonlr UBodAted «illi 
the ikAirolic Igm p eramgrt a nstdlly nm«il as ii the maBitv lown jaw 
ol KTomeGftlV' The promLnctii >quaic jav oiul iJic rctxdiiLic c)ud 
art qnircnulL^ UModAted vith (innaeaB or the lack of it. hut the co&- 
daiiuiw are «H>J«a la ik^ubi w ai IfVAt to mary rxiTjiliuii^, S^iaam 
of Ifcc javr sugxnitt hjitrria. iMjMUt, sirychniAv pouoninj^ trumiu 
Bconaionni. rrflex spurn in chltdliood or irriiatiiMi nf t-vrrhral origin 
lt> opfKEiIu. ptmly^U may be oolcd in pontine hcmoiThii^. dcuiuu. 
hrein ixmor. moixa^tit. dc- The jav mow- 
mcni iiiAv be Rtutt *>i lo* ifu(jr<ic^ in lueh 
dlwMn 01 <|uiniiyH raumpt. &nil lAchintuiflr 

Tbe Sflfl PaUlf,— SjphHilic prrforaTJons 
\ia\t been rvKfirrl lo. P&nlyiLti b luuaJIy due 
tf> diphtheria, lai mmnionly in nrivbnJ lunuir, 
mrruiib^itU cmrk» and Mb&i |i«Uy. 

TU£ HMDS.— A«ld« from Uwftti}p^U(»r 
ocLUpuiiui). liie han>I>i ailurd muth informuiioii 
of ihp most (ujcgvstrvc a«rl. The hancUbakc 
ibtflfl may hidirvic a bick cf rignri inrmfir may 
oficn be fcU ai tKcU aj wen find what wcRi» 
like ft merr inrm%hty may conirihuic larjtrly lo 
ilUtcmno dril |Mi>i£]ii.ob^ Pcraunsuf llic luUrr- 
culaf tyiw tilirn Fuvr han(b, dulirale urd fcmr 
oinr^ tfluoly uirnprFSKiJ mil wtak ttn gnup and 
the llnible tkadtt boad of the ncrvaiu pcnunn 
admrpi; cnnintiUwith the durnsier onf nf the 
phkKPMtic Ijpr. In vauinjE linv-am Lhc haud 
fedi ba(. dry anil flabby and ^marjuticin it Maily 
ifCo^iicd, V on dcfonnilica of tk< jornU due 
li> chnajc rbfumatittn. goul or rfaeumaioid 
AitMiUL ihe rlubhin^ of Uxe finger tipi nf 
cbmruc puUnonmy diaoue and the jpani hand 
nf •cromeffily. 

Fia^tr lt«£la. -CAr^ntr bdoleni iikccvtion surrouudin^ tlic mul 
nggntii syphflk or mart«d maEDiitrrlion. Thr iiKun^ti nail uiodatrd 
wfib m dubbed &iistr tip b a aj>?i uf (hr&i>ic pulmutuiry ur caidlni: M%- 
tue of the obitnictm type, or an Advanced pulmonary |^xb^Ic^3^t;J^ 




t, ArAriiit 




ItTtltr-At rtACKOUfL 

UriltXt OT 

n^a ouu- 



Dhttlc, slHatcd or »plii riul* moat trt<{ucatly occur n co&sectSon wich 
L '*' gDUt, poipbtAJ DCUftcU. and prolongrd rKpoeKire to lb* X<fUf . Man 

I Tra»*rr«c , inportADt cf ftJ Id ihc CA^C'Ukcr ux ihe lAi^AVCtM ridfc* bdicatinf 
I '^^***- I X ptM. wvcR illnn*. ThMC uv euily not«<ir lut l'>7 ft pariod ol owr 
L A or 8 monitu. ind by ibdr pnmtnitx U> the nulra icdlattc appion- 

I matdy ihc date of the JUnctt, 

^^^ THS ARU Ain> LBG.— Mnnj-MlherandJHdEUnJTetdiiilhttver- 

^^H tnaillka Mjdi u tdtntK ptin uid Icndcnoft b«vc b«c« discuicd 

^^H under xhvir appropHatt h«w]ivgiL Hirrl drcunucriberl bUiltnl »tfHl' 

^^H inp upon Ihc ulna or libia air tuuuUy syphilitic nodo. Jind the mort 

^^H difiu»c, bi^jitral, painful colarizemc^ms of the tibii with cocturul 

imcrtbAlJnn %rr ttso usually cfphilllk. Ijtctdii^d rdjmia ui^ AmT 
a»i reitic^ 4nd Kverv tJccp tettcil p«iii over lor^j^ bonra und cspe- 
dsvlly Ihe tJlda soggeit aciiie prHnfiin^ whEcb may ka<1 to dironic 
fialuJ^iu Dpcaijpp ittdiaUia; ^MonJftry ncvcwix EnlargieaKnl of Uic 
loff«T end of dw Jti^w lujcf^uu ndijti& nnd caoqniKlcly imdcr 
hi&wny Jndaral[i>Ti over llic femur In ctJIdrcn Jii Hn nlmcMl coi^itun: 
sijcn of Kurvy. Vdhcoac vdn* ftrc common in Ihc knrvx cxirtmiiki 
Lnd miy b« bUarpnl or unl^lpraL arr nff^ OModAtMl in noddle aged 
or elderly pcnona nitb chronic indolent ulc<n ocd may produce h 
mUEcadjng cdemft, Conj^ntioc snd edcmft with pftic and IooIumI 
tendcrneta tuf^nt phlebitis, and \tfftif>taX\i\f^ ulivr uauUly undtr lh« 
btJl of Eho ffPUt toe nuy be prvftf^rt in iocomou^r aiaita or nnly ld 
rL!abrEn. Dnp cynnouH of the foot or lorn suf^Mli Raynaud'it diwur. 

Im J^*W bill! or ihc eiLriy ataj^ of «n <i^u<if lAnzrtt^ which nuy b< asaodatrd 

H with injury, nrtcrio-icbmii. rmbolUm. dinbctpi. fitnl bilCn eritotiatn. 

I RayiwtidSdEMaaeuidranly<Ubd&ixDcd.ciophthAkaIc(ohrc- Molded. 

■ ducky »dn«BS and pain ow Ih* aol* of the foot may indicate er^1bn>- 

I mdil^a. The proerKe or lilseniY of puliation nhuuld br carefully 

^ noted in coEmccton wiih painful dlsHuca of the lower extreAUtica 

[l^,^^ Mprdfllly 1* indintiing artetiiis oj inr-iplent flnrigirne- The mlAr:iE^d 

jElnnd* in the sroin or fenkoraJ trianjcle auKCcativc of ayphilia, Uiaxicnid* 
HodfEktn'c di#*ac«^ tcctkemia. nafignjwi diataup. etc., ihotUd be noUd a* 
■ ivcll Hit [he nitarj^ epLlrodLlcur ^a; id of stphilrbibovc the inner uonil>1e 

of the homeruA- Traa/tftc'piwt^^rncWiiifj usually poinlcia and subnd- 
ing with brui:c like color rhan|^ urc nommtin in n^ihrma nnriomm- 
Thc rc^on of llic hcmUl 4>pcriinc ahould Ik chnrfuUy TJ|i1cirrd, partic;)- 
bidy i\ riThfrwUr uTi^irilahiLbl' pain eft evldcncf of inteaiinal obftnic- 
I tion arc prrstnL A disLUaaioo of ihe Ta.rigtB drfonuJlie^ ntid joint 

I^^H diatoara don nor come within the &ccpe of tti» book^ 






THE BACC— The tlefannititt ol the tptnr an? eaminUy four in 
iiimb«r. (t). Ltimd 4tv9atmv JKtMotu) moat Uvq^cai ia yonuxf^h 
vtA due to Canity podbonlatundinguid thtlng, tofnuacuUmeskncu 
or Id pmcnl deb^Elr u ffnis radillb. Ii &l»j rcMtlU fruru Jiruiiic 
Jbi— r of ihc limg or pkun. par>l;fS» titocxing po4iuT« and mollititt 
noluB. The defarnulj^ U tddom exlrcoiv in ii3 ordinary form and is x^i^f 
niiially rcmcdUblfc (i), Z^fiiiivLf or amfg^ntcii boimd cvnt 
■4 ctirmpli6«d in the Uicr tURrs of pi^p^ann^ li tnggptu ttui con- 
dition, Al>JoanbiU luiuoRi, A*dk* «aH pKuJu-muscuiu bypcstrophj. 
{j>. JCyp^cu, if thirplj angf^l prrttrrior pvoJtcttOQ of Xhv «pit» it 
pnaml FK4t% (Eacatac ^BptLid taiin) trr mullilira OHiiun aif suiiigeiled^ 
It b canmon ba^ftwi u i eimpk todcvonl pfDJc<iion in the dortd 
rn^ut, to rfcfccu. tldiSiiy uid duodc craiJIijvTnju frnmnMUlif of tkt 
tpim, — ^rcoxporftry xUInc** nur ^ ^'^ ^ eoukuUi •»«{» or rhcutuA- 
iiMm. iBd cbmalc rigfdtty inrlkntec hnhriTU dcAormAnA, pml- 
pii iffiinfli Polt'a diacnc or the curxjus tp9niyti4ij rhyaameiiqHc, 
A fuMcM JJK^iw of middir i^ mm, commencing m the hip 
JoIau Mid «3cmdbig upvrards tn fhr ipinr nii'l shnuTdrr. ih<^ rcmU 
bcinK A tH^ h^rphoflc 9fAnc nnd uicbyLi>I^ i-f odicr «fl[<( tc<l jnint^. 
In olhfff cun tbr dlanw orlf^nam in ami it timil«cl to Ibp spine. 
Tnawrf mW ^iMJlMff. A ^Ai taricly aic discuastd in mrf^cftt| 
■fid orthopctlic workft and the congenital ipina bifida ak«cT^£i«s due 
to carici& fatlj tiuDora, brd waia and laanl edcmn art frci]Lifntly 

THK JODTfS.— Tkr fcAovtoif polnii thnnlri ho ^f<Tf-tTnini'i1r — (a). 
Pft^tnet. cjrifnl «W £&4ra(lrr 0/ n^ktcn. nr«C/tMj; iia^ ie}<rrmty, (h). 

Mi^^nroJiMi, cA»mv raAd«uAffli. ^'•jC"' ^ c^-^ recognizfJ otuiaHvi 
tfr pn4iipttrimg fvUmt. la Ifcr kTW* Joirft. fluid u mo&I rradil^ fl«tected 
by fdlj ****"^''x ^'^^ wppcrtmE the rjilmnUy and mnkbg dovn- 
vard pcuw upon the ptwtU «hkh may be fdl to up ihc articular 
surface (Aooilnif of tlie pattlk), Or^iinjuili the utiitlnc k4 the ilialciidrtj 
pjmnial mrabcnn* u vudi a c»ac is (tiELracierifCic 

Ow^raJ Conmanl.^lt ihould ht rvratnibcn^i thir rn a€atU fAruna- 
ti^m the \ujea jointaarc chiefly amlpriniArilvaiFcctcd, usually biblcr- 
tlly uid In 1 (kftniip onlfr. adiI rbjai thr ain !i moift. the sweat ! ^"J 
Mid. C«Ttr ttid aDcmii marked. In ofuff loitt a ttiifle joint, luuolfy ' 


MTtnt-Al DUQN0S15, 







tJie grrat lot u jirimuily ftflcctrd. « iKrftn^ncT i» shown Tiir tlv mill 
jointA, ihf actual )«in »a^ throbbin^c uc j^n&tcr and nwrv pu-- 
oifsmil than in rhriucalUm in wliitii thrjr an dii^}^ udl^ hir mavt- 
nuQt thoof^ of Uic <Ll]|^teM de^ve. In dhrm^ rAflMKoJuiv deformity 
u as a ntlc not t^xiremc hvtr is nbMOt. dMnges of the waUiet muk- 
cilLy jiiTnt i( ikivl cxMciltailva jiniJaul>sidtnccw«iticfu)c. InarfJbrlM 
dfj^rrruas an Kutc pnnuiy ailUcfc c^ianot al fml br cliMinj^uiatitiT 
tnttn Hcutr rhrunrnliMTiH but it b fnorr pmiMfni> rtdiii Ifu rr^ilj 
to apeciSc inatineni (nlicytatf*^ «bcO> ta4 tends ultinrkatdr to bfaoomc 
dinuii^. xht jointa ^luig on movonrar, drlnrnajng md bf!Conainf 
fijicd. Both larKe and aniaJ] jointj 4jx tnvcd\Td and the diKUc IDS} 
bcccimf ulmotl unt\crml- 

Svptic Anluitia. -TliiaQ<:LuniLhid1j luthrcuuncof urimmcdintd| 
f^UowinfE bcjK inferlioiu diicaati, espedollj KikriM ifmr And dcnjBiae. 
anct ti rommon in pysntin and ^oaonfiaa. Thr infanijle form of 
icplic anhiitb may occur without vx Kuiffiuiklc catate and pn>icma 
npEdly to tuppuratkin 'Vhr variDiis tuttfrtvhm kti^m are boo 
numcnnLS lopmrLiliff di»cuuionln iht^vulmuc. Our uf the ujvuniom^ 
akiid tnoet rvgnltable of nwdiol bluntWn i« involved in the »i*d)agno«is 
of osipcMnyeLitla loo fmiucntty diigmveiJ aa ftcunuiiani. Tlir 
uripcnl need of ndlc&l lurf^ical mcMUKi m thcic cnica make* It impoT' 
Eant that one th^uld rrmf-mbf-r thai ii i« theepApbyvn that an* chieflji 
bfolvcd calhcr than tU i<rirtl ittdf a»d that tlin dbcur is clbliactlf 
optic m type, pa£n ciirem«. dMp BMl«d and boriaf . aind £imher tlAl 
■a in rhnimatikm, aenral ioinla may he inmivtd. ^ Su alu in l\v bem- 
orrhacir dialltcais such ai bcmafihUia. »cimy nnd purpum joint, offrr- 
tkxi* omir Wthor rhruTnntir in chancier or due to kfmankitit. 

In coanccii'm with oruanic ncrvoot diaeoM «^ tnrct with anhrop- 
UUflL In t^omitiar 4itLtij >nd J7Kiif(im^y£«,onft <rf the large jotnta, 
ffUKBl frcqudilly the knocH «nLlc or hip niay become suddctdy avoUoi 
wiih Mt «-ithoi;t p:un and go on io rapid dinnlegniion (Cttarcot jolnu). 
tn ronn^^lioTt >i[h aII chruiic joint allccliciru then may lie marked 
mHACviar airof^hy btil ih< rltfirk^ ftJicti<m$ arr frtttrwd. Ujikru4j 
jiit«tf truy CfVttt* nu>ch onnfUAlon beiniE extraihTly trnApr and fie- 
i^ueiitly contrattttrrd, Chom ia frc^UA^ iMOcmIrd with what b 
probably a inic rhniman'c anhrilb and Aydttii may be accompsniad 
by Ibr* ^mi- niivljiiiiJi 

VOICE AND SPEECH. -<>nc abould Uiln ImdikU to ourrollr 
nole i<ajui{on>t from the ncinnal hcaliby lone and enuaciaticA. Even 
ilie laity ftcotiii£» the ouioualy aofi M^iiltcbcd Tom of the frfilbUfcaf 

nn oiTTVAVk sutMf or onsAsc 

patimi, oJLen imlcvd miCouninvd in Itxxr flouring mrirl^ i lubeKOloiu 
irnrdiipoNCico; w also duir Roaf^nbcs the Unrtk \'ixct oJ the pfoatitute 
and Ihc Ihidt nu9!»d tone of the victim at tonEillili«« idtiuild ditc«jie. 
or lAhcrwbc ofaimcttd ttotaX i«*MRt«- Havtmr^ and aphonia 
an U tinea ■jTRipUa* of gnat imporunor, poiriUngto jcuu or chronic? 
huynprnl tUsewa; lh« wkiipfrmg voice iiLjLjr br due to lubf rtuliiw ur 
naalipiMtt luTniplia, hvxcnc aphonia or patalrtia of ch*^ ab(Iu<Cicirt. 
dua •ftmtknea nn ihe iutseutp M an oiteumm or mftlJaKiimil g^<TWih 
ttpoo ft fccunvol tiifyQKcal nctrr. Shv. itamniHi. syltchk jpMck 
ODOiUnfd viih vi fnianitjijn ircmi^r iuje)p<u fllurrninaiod fiflcnaU 
ur W7 r3in:l)r FritiirHtli^ xlaik. In pamlyvs ai^iLaiii liic trmfttda 
spM^ may b« «noounirr«ii; in this a tt«ntmce U b«^n slow]; and 
with hsitiiim. bui Jniru^w in rapiiUi; And Fnd;i In a Ktoitn of wonk 
In ttwnUMi [i]ii>T7rifc( n1 [jarutvait. unrotTophJc lalcrti tdcroaui and 
paittdo-bulhar panlym. enc nncminlfn a mumbling apcrch. auAciaIrd 
wlditMnux-andalioptiTof the kmKUc and curious imindbiliu of ihclipsn 

APHASIA.— For nomut piucMm it it nroMnry (hat the ctnirei 
mhI iftrrhantim for llr pem-ptinn and rr-Dcdktlidn of vpakrn and 
wrfltcB or pHftlcd wordl. of Arliculaiioa and of aaoclation, shaM 
htf oomuUy active »Ad harnutnlrnj^lT Ini^rMtlng It in Fvidrni ihai 
varimu dbbtviiancce may uul according to ib< dumcici and loration 
of the loioa. Fuftherm»r«i ttai we mu<l diKrimimte bdwcvn aphoiua 
And ibc laJm of paralysis ot palsws of ihc ohumIcs of ortJcuJatinn 
(ansitlirii). True aphaM U usually of centnJ ort^in. the peripheral 
inn:fuiotini Innj; laulTntrfl 

HotOT AphaaiA. -This must bcrccDKnucdfudistinctfromscnaary 
aphatfli. k is <fa>i*ctfrind by tnabQily to xvlunlahly npmj by sp^rch 
{af hemaa). by wriiinit factafihai) or by gcsluiia tdniimuf irhat inaybca 
ptrfeoly dtu mental imajEe. 

SuMOfy Aplmtla.rin ihrtiThi-rbHncL Endl-^alctu fHiliin- in undrnund 
itr nrofjtia spoken wurU faiU'f)r<ir>' ji|>haMa, vrurl drafnno^or written 
wonb fvitual aphuo. vrord btirdnrM) \ largrn umber nf ■uibdiviviont 
ociut iwdcr bodi types, nicb ov the leu of poncr to cany a tunc 
Of write musk, or on the «en9»ry side a failure toioierfifttor ivcc^ii^ 
muakal amnd* ur ttotaikm. SttU anullm variely fimiaphaaia] txcun 
in whldi «raa|c imm^ or chatacter^ arr ipok^ nr written, or the mine 
word rrpraietl. 

ApraslA.— Dy tfai» b oacuit o lo«a of itie faodty of reroxrtiung or 
appmiatJnit the kbfklity, in:nv and ium of objeoi. ttnd here iflidn 
one has Tvious sub-dlvbto*. lUdi u mirid llindncM (vbiual amm^). 





neu mil 

blind Apia- 


HKsrcj^rH tMAOifosa. 

mift'l deafneB (tudiloEj jwtn««u), m w^ 94 tenai indioting as 
inability lo icioj^nlji.- jinil iincrfini uilonk, Uun»H etc 

TRBUOR. UodcE of TofltiDjE Tromor. To diMbptiih IMvmb 

poiftfur jyvmisr ami i»tfiiiipn trrmfif. ^irrn ihr paiirm to mnlr ivnnc 

iiw¥Cnicnl ittdi 09 bmvolrcd in likin|cup&D<l fubeningi collar butlui^ 

I bttttoning the vcsi, or drinking l ^^^ <)' w&Ict. In Ihift InlT^r nricty 

Ihc Imnor U greddj incrciucdby ihcDO-grdiiinteinovemCDta invoKcd. 

(Lpd mdccd tojtj be whally nbvcnt wbtfi the patkffil a at rciL AH 

. AwffiOM 0/ ikf fitircmitif.i iir« tecfWMd A7 tsOovhiK thcrrforc th« 

' p&tiont sh^d csttond iht arm or \d% in fiODt of bunt keeping tbc ricfdv 

or Imri trparultd u vridt^ly u posdbt. Again if Ihr tips of IhpliEgm 

irc aJlowcd lo toL upon the phpidan's palm a vibmtion olhtrwbe 

imperccpUbk may b« narUly detected. I>cmoTi ol tbc mu«d«a of 

tl^ face niaf be cdnplmaucd by Hx linn cluiturc vf iht iryt^ ctcvalfoQ 

of the c>vbn>wB, Of by drawing tho cumcn of tte moulh down or out- 

vnrii and livmor of tlu^ toague Is maricifdly incrfa»d by |irotnuion- 

In the cax of individual muMlc* ot muide icn>up» b varioui portioefl 

oJ the bo<ly, puniiig these In acilon or under ouillnucd finb uittHy 

. incn^A^.t thar movr^mrnt. Onir <ifaDul J noic vrhrtbcr he a dealing intJi 

I a fMof w xeiHrot, ^sHvfi of MilMlun. ««irj; or fiK. rafid of st^tr, 

I CondMom with whlcb Trtmor ii A«*ociakd.--ThctrcnaijT cf 

j advancing agv iin<l ih« nirvmeCy nr« (i^nditi^jn ol ctingr-nttal or lAhvritcil 
tromii ore unimponnnt. ju 4tr those duo lo 1cxnp0i[V7 uervoimcM 

) or ovcnti^'n and tbc cvcnwvc use of I«a. co€ee or tobacco. Tneinor 
En aruir d{««v uvially Indifotea a pmlound laivmia. bdtig ocw of 

I the unfavT^rablc vr^iptonift. for e^anrplc, m Ivf^njd fever, and It is oftal 
tnnounTfTrd h ihr Typhoid star* whaTt^vrr ht Ihf nnrifrlyfng nrfgbial 

' diaea**. In olcoboliDri it i* tiol only a prooilncni ffituic of delirium 
trerxLciu, bul nuy often enable iLc pfayjidao Uf deled a recent debaudi 
Of |)ieaeni cacenlve poUllnu. Uld If cnarfced aug^tiu ihc oniwl of an 
acBte acudE. Sudi a ttvmor ia cediaarily fine, regviu and f»nlit«il« 
and ytfTf sfmQar to that of dnig hablt^iatinn. 

Bxopluhatmic Goitre,— In ibb disuv tbc tremor u fine and rapid 
and if uaodilcd vitb a Urjce diyroiil and rapdd pul«e wjib or without 
evoplitlialnnai. tSe dlagnotb i> made Ever? suspected ooe abotlU 
b« ^tf^\t:i\ \ttt ttTfrtftr by labinjt fbc finicer lips in Ibe pitm of the 
Para1)^ia Agftaiu. — This fe ordinarily a rdaifv^ely iJow 
ftrst aff«lin^ The thumb and foningrf and cauvrf; a rolling ^^^^ 

I of U»c tbumb over ibe fArefinger tnoivn ai the " fiill-nnking" or 




r«M Anpl 

I iRfnar- 




tnmt* U <Mtdud ty \4 i i ii ttmi aK4«««nt In ib aiocv t^vAoced 
$orm t1 ouiv involve the unu. Up und fwul. 

Mineral Potooing.^Acy <tat of nchcmne unFtpldnod Trrmnr 
abould mscM the ponlbaitr of pobonittjE b^ totac mod or (Inij:. «acb 
tf oocaiiv. opium, ■rvotr. Wnd or m^ntu]7- 

latontioa Trtmor.—Hus (ondltiun Au|xat> Alw&ya diasenuasleil 
•dcfiMk. but m^y he net wilt ia ai m&fked Ibm u a nnik titinof | 
or cwn in temJ pobondnflt 1 

TNtaor of tb* lltiscl<« of the FacC- -IVilchinff cr flkkerinj; of 
dw fidil raivcfn nrrrcijjly tup!)^^i prnfnund nrifruihmiji, p^imlt r>r 
dinmc akobolbot- In pro0tMm m^r^Ur tlrophir jurcnilc or spinal 
(wteltfl) it miv b« obmvf«1 ir nih^ rrfF^or;s k% wHI. 

cfBittp ahookl be rttervtd k>r t ^dM/uf. spumMtk, imiiqiUr coa^^ 
tcittponry and locstttcd- Ii ixwy be ■npclBUfl wlib nlcoholiftm, i^rjiit. 
dlibctaa^ Brij^t^s d^Hur, bvilcm. orcirrttiTv muscular Faiij^F And 
flMMoomirkO&ly ifito>v«sth^<ftlf FQUftdM. Thfromtdxitovrruccofoii* ' 
ad of niMcIn «udi u u met iritb chiefly bi ibc txcupoifonol rLCUiosn ' 
«4l7pi6ldbyibf »XttIl«dKnTnier'(pabymftylAk*Iho ff rrrn of <»tinp. ' 
though [iec|iitttd)r ■ fimplr ti|M4iij. nine wnkiina ar mi ictual paral>'au. 
(9^ p. 49). Tbv term ii qiillo corrfdJy applied to painful eptiain of 
the invpn surik u is involTrd fa trxial or bUiauy colic. 

Wry Veck.— Tbli may 1>e congcnitai, tmuoifclic or purely ^pumodlc , 
«ad m\t Cor ovm ■wnrinri witb ictua] munutUra ai or nuhiioqLicnL , 
to favtb, rrpctarob > (Ibnitbaoce «ffeaiiic Qic «}>Lf)al iLLEjrsAiiy [icne. 
In InW con^niul wry Mck thort i* atropfaj' ol Xhi^ stcnio-mkstoicl | 
(nanlly Ibe ri^t) ind f>d>J ■ajrnu&rtrj. u opposed lo atctv inuadr 
cftJIovi due to nipliue «i ibc time of delivery. Spnamodic wry nock nay 
be iontc, donif, or mor? rudy corobUaciL utd kaj follow Injury or 
cxpovttit or be * utic nrmosb. In uiy crcnt the tnuadc croup of 
fpimi acconiy innervslion i« fhic^ify fnvoJvcd and the tpium of Th« 
roUinr* dev&lA (br chin mi*1 rtriLigt il tow»rd& the und0rctni itrlc 
Tbe ihoghiCT niAy be ramd and (be heod drftwn deddedly bockwArd 
ff ibr laprrfrH br nuuii Cntvlvnl. BUBimJ spajtm dnwfnp ihr hrad 
bocft ukI Ihc face tipfr«id i« rvc The <lonlc qsMnu orr paHicutarly 
(IzfllicsdRf; and unlortunaMf ch« dteoar uiiiAlly iMdb to b«com« ftw4. 
Hoddinf Spasm* — TIm condjtioa b wualiy a neunw» pauiiculady 
bi tu adbll form. In childfa] it imy be ciimeljc. rtHtx (teel^ing), 
or aaodaeni wtih tVkeUc. OoiUr ft;iwm c^icdoJ^y Q>'aZiigini]ft and )ndt 




\'ar!tlif ■ 


lulucrtl I 



oflen stMbismLu may b? usocUtcd wiih h. TIk OicBlallott* ccuc 
ilunng dc<^ and att mcrrosed br cadicnrftt or ivbcs ondcv obierva- 

a$ei nuir bi^ panly tmuiVnL 

Ttttny.'-'niif LT»ndili'>n » entirely dittincl fmrti tmmu. being 
mtrcly ■ biiatcml ionic ipawa of the utrvmiiioL dllio o>mJ]ibou» or 
pttrorj^anAl. nval commortJj intxilvinR the Imi arid handi, kai cillA 
the (mcc nrck aihI J«w (irisiiius), nnly alTnTii^i: t^r niusrlni of thf 
tmnk (Cxj^e^jLivc muacuJur irritibitJIy k rvidcnced by the scIttc 
ctKitrHrliiH] foKiiwmg omij>maiwi at the bmrhiiJ BTtoy (TiouArvu'i 
,«Sn) or «%-ai the ligbtcsil top, ruonbcaU ffikv i(klli>w ibc tightoi 
1 prvdre upon t Acruary ncn^c, fcv«r m sometime* pmeni, ftud the disFftM 
b luiially pvoxyutid in lyjtc and umkUiciI witb oitiicd dcbilili' 
AffiMig tho nn nuMt arc p4(rr< l4v>^> [in cium of dilatarioi)). ti^d 
remoral of thr thyroid glaml Thr divniur li tumrtiinrt rpiilrmk 
bvl n «xtitmcly nre in ibU couniry, 

Panimyocloiiuft HultipleT. - This lyndmme cavtrt tbAV pefnlltr 
ewe* occurring th\e(\y m nwlc^ and ol unknown c^uMtt^n. in wUcfc 
donJc with occuaonil (Lvnic tpcum ocrun< either consbintlT or paruiy- 
DnaJl>', unicmmiuininl by amfwry dinturhinc™- Tlwac arc imuiUj 
lymmctric^ and rbylhm^tol and tttuie during sleep. 

Athatotd HovtmoDCt, - 'i'hnc cuhnuiily drliberatc, wrlihhig, tvj«t> 
in; movcntcntA t>( the fiii)En> ao'i han^U, ni'irt nrri> of iht fret and 
toeti miy rv^iJt (mm mlantile palBj' or follow henupkgu in *dulli^ 
Tbey jure ibiwer and let* jerky than the mmemeata of diorea %iih 
which they ore AomeUincf ooTtfounderl. 

Uynldema, -C>nr frnqii'^ruly nrti-^ h mjirkrd ITrrrTn^, lootKud 
ooQtr^lion if a mudclcbc shurpW lapped wiib ibrfinfsn' Thit t'lvxrom- 
enon i« f f prcratJjt oommopi irr the imifdaof ibtr ch»i inronnrdiun mriih 
(ubcrculmb. but ti not n t.\^ of ntMiktd importance, 

CatftUpty. -Thi« extntordinvy ftrmt^r>m indlmtn byfteria, but 
may be emtiurtrrrcl in melanoholia, braiit tumm. mmlnKEds. or be 
produced by tiyp^^^ '^^ ■bich >l constituLa the ncvondiry stacc 
The patrent app««ii ajtep and thv lirnhs rrmrun finr [rinum or houn 
In the pOfllilon in vUdi thc> arc p]>Kcd. U tt nftcn autO'hyp^otbm. 
the ey«« uv cl^*<l. roUfd upv&rd. the pupkh eoTiirai^id and wiuibility 
ID pain xnd «pr<it] anci ifmrnl nen^iiikni i* ultolifhrd. Hie duraihm 
of mch attacks h often abort, but in rhc <ntjLi:pik aitn!f>in|; j^irts (of 
ibf nrV'-ifijipm:) ihe attacks may niilurv for year^ sttch ratra bdn^ 
I able 10 Itcar, t^kr occasional nouriahmcnt. and n^iond ;o other atlEnuli. 



EyMCrittt^Tlt acltui study of c&sce ia ofccnftrr to kq undcrvtondiniE 
of 1^ phjniogpiomjr o^ dfrnul ipimranm of iKk rttnordhiiiry 
coadUioa. bill ofioc a luijc aumbcr htkxt been carefully ubfcrvrJ. the 
dilBcuhk* arc IfL^gelT daw svnv with, I'lic t^ptc hut bctn <f(dlL wrth 
CBliTf uid lltr rewlci i> iHrrrr:1 u< ^iHtr 615^ 

nrFAITTlLE CONVULSLOnS - AiiHCk8 |irratrty Kimikiu- to thoat 
d cpQep^r w HJffirring in vimr inricular^ rnn)' hf. obwrvHl in bnih 
chiklncQ MiA adulti. In ihc former, thc^' a\ny be <4uc co jfcncrU 
KUlouCridon. rhher prtnuiy or KMnndiry 10 ditrur. to hckftCn Xa 
fcvcf u B 90 FnqucnilT tctn oi lliv onwi ^f a<uir mfcdiuxiA 'Iunaht). 
imRif ia COllgMion til ilic bnto and qutk- crifnirrrrly u rrflfX plir 
nnMCTion clue lu pm^erii iituni Dituiac ur irritatii^n such ox 
dcQtJlkm with iu »iaDd*l*(l d^«<tiv« disturluiiiots* phimosia^ cti»aMii 
td th« cy« ofid p«r. B-nd posdhly intminal wurn» may be oiuutJvf 
C«nvul6Hin» ««tunpttny ihc Ijtrt^r number of cuca of ccrtbtal db- 
nar in fhililrca And one obrwr^rA cxr^tUinRllj in young infuitt ft 
gniftiMlI} dirbjnishiEkic Icndcncy to ornvubiTc Bcimrra from the lime nf 
ihcit linh. 

Syinftinins.^Aftltlc from Ih? miul finFmoai^tary i^pt^imK nich flii 
«l4Khl «i>Hchinj& l^rtb icnndiniL rcstlcvnc^ ^r irrltubJiTy the nFTnrli 
U prc<iirly ftimilAf tn Ihnt -if 0|i!Ti^{My Thi* dfAp^njui^ in rrfiruTrr! 
■tUci> most ofUa depend* upon vhdr Bubaidcncf or diappranncr. 
when a <aiuc U hxinil and rrmovtd. l^hc infant morta-lity from tfait 
ftHjrte li coBudcnUc wid unfortuajtldy « large number af tnic epFl- 
cpeacs coortmcncc during '-he ^nr ihfcc yeftnof life, over a third o| iS^tm 
iBveili^pd by Oiler ofn^mrii^ in the Am yoir. 

DUlDOob- — 'n any uwc ihc 6rai thcKiNfit ihviJil !>c of the on»cl of 
OH dndr tH/Ali#«i ^I'lATf/. nc fjff^ ^yrla^iMg pf ihf sktH^fk nrd 
in^tij^ifmH two laiKBcs «tfaiih account fi>r by far the tcr^^aicr numlxir 
i4 BUch alti<|[«^ /; f^ fiW«}»A u ^^rritCrfM ve hare ncii only lii Lhmk 
c^ciiJkp^ bul of \hc nt'iiMi, iVtiKiia afloctinir iht bnim And iu cmiT- 
lllC>^ AiItcwmI 4iaM*e tho«|d aJvavf rer^ive fonptirlri«tion, 

STATIOir, ATTTTUDE, GAIT.- Surtr auiiii Ik i<*trtlV- hir 
iti|e * pfti^MU Band wilii HcgLb anti lout tciK^hci and eyes cb^ed- 
Markod vtAyhig (more thtn an inrh or m of evcur^ion) iujtgnTi bco- 
iwitae aliLUi- M/ni^rc'ft diwjK cv a Icsiaa (tf itif mid (rrd'icIliAr luW 
The pATiVnt miiy <w^y viulemfy tnil hUl unlns ck«dy uaTclirtt,* 

DECUBITUS. —I" ihr kvlU^ft ^ktiL Ibk chief dki&li)n« an ihr«^;r 

*()ac v«Sma anlli drvrribrd hii HnuiJnn im thAl of * "ehJckm nd a 


9f <k t ' 


and ^OTfTtv. dersai amd Ukfol ud It mkt with tb« oondAkn <if 1b« 
patient and the bc^ucd niiiirt cf lii»di«ane. Etcq tlie Kvcm t jpcs 
of ^umtmu do not ri>b the patient of his active ilecMbiCui. v^ddi 
coniTjMn Kimnsfy with Ihr pvaivi- dccttbltitf Q*]ilfied by nme lyfhM 
lever jn which (he pnlivol lid rcbsci] and hdploi*, mutE be moved from 
«icf« to iklr. ind ttrcaiionJil^y str^I^iTfinM oiil fo r^Zi<*r« ^e fmnpvci 
Ijosturv or pinrcai his giatviuilng 10 the fool vi ihc Iwd, Tbe teems 
dortai And iaifftri npbin tfacnis«lvtH btil tt 11 imfh^rUirl lo note whether 
llie jttiicni chiuiifr^ v<ilurLtanty fmni <inc Ea jincithcr or kvhclhcr ihrou^li 
csMAt wttknen* or because vnovcmtat lo n chnn^rd fXf^ition invoivf« 
jncr^ued pftin, })^ malntafn^ n f ml pri^itrr In gvnFnd iVw min with 
itppcvnikitu lic9 on the back, often wilh Ehc rt^ttl kn«c drawn up^ or 
in £rmerat ptnlomiit with boih kn*« »o pla^wl. In t<ve« tbdoininal 
cnlk^ tltcpadc renni, ctd the kncci urc dfim iJniHTi rJoic (0 ihc IwUj 
and the LiJa^j/ (in/«J p^jitvm in ci>mnion. In (he tfiiriy ^iokc of > 
platnsy. with ur witboiil pRtUfiiotiia. ihi- fulf^nt ii4uall> Ifni u|ion It* 
afT«cte<) »dc probcLbly lo limit iDov«m«il of liie aflectcd lung nod 
facilitate tbat of ihe e:iund ont, Uicr in thr diMiu the position a mor* 
voruhlc. All u^iifc memnxiikJ i* duULilnicnt bj rij^iiJjty anil CTtrac- 
lioQ of tlw h«ftd 9Ad n«ck glvingiiudiiftirxijve^ppvcmficc. Ink severe 
rheumfiik frvrr uir] n-Hiiiii taun of infantiU scvrjy ui(] riikrti iht 
patient Itcj np'dlj in n domJ pcoition, his wtole iittitudc caiprewnK 
S(q>fichens^n when hii bed la Appmachod or any dTort niai^ lo 
f^^'T^"* or hjindk faitn. In cases of heart <ll>cue in which compciiu- 
tion ha« fail^ Through whaCvi^r <auM. and in asthma and Mvere 
rmphpetrm ur tfliyngciU ubaliudion. one is likely to ftnil the pmitEar 
aiTlinj; posture indicative of orthopnea. Jtt fii4 krfaimd sU^f^e aj mjlrai 
Utimtk thefr i* oficn n )»fculi;ir Iffllpw mlUnR nf Ihc h«id fnrni afrte ic 
vdc wh^h wilb tlic ana^^ru. hlurroi futures. cyaAosb and ortlwpDcs 
mckkM a diancieriaiic iWciurc. In so&w csM« oJ oi^urtpn, «uf« 
oorfiaV or mtdif^nant growth iiiTcliriiif the medkatinump* ihc patient 
tiot only nils up but musC l«n lorwnnl so 04 lo rest tbe head tipon the 
'knees or upon mneipcdal support pmvfdrd In n rnu nf Hfv1gbin^« 
diMaM cominjE owler the author'* ob»errslJotL (hia aTTituile was a»' 
«umed for wftfkt brfore ihc- paTi^ni*a dmtb. So abo in iiiphragmotic 
plcuriiy the patient »nittimca sib mdined towordi the attorud 
side. Mo4t <arefu[ attcnlion tbould be j^ven to the alblvde of 
an unconKious patient with panlraUr rcfererKc to |ianl/Bb> olien* 









*Thic »tnr nnilaJe fiuy be awumcd ocfAbJcmaETy le enacnie Incompcrfis- 
adoD and utbnui ic uiiurr 



liaxa tbc «;»pc4nncc Asd ptJMvifj of ta ft6<clcd member or iddc b' 

OAIT*— WhcD pmctictbtc tbe legs »litrul<l be uiico<veiRl froco tbc 
bipn dcnra «ad in irom«n the ni^tdnsd or ch«iniK may be brou^^C 
lorwAnl bclwom lljt Icic* aad faaicucd ah^trt wj a* lu permit Irxmhwr- 
vilioa tmd movcBKAL 7A« paHeiti ^ktnUd teaiA briskly auJ lk<n 
timdy. %Ml Urn *ya ^fem and iHmt. itop oHd ten tharpty el comm^td. 
^m4 Iciltw tf nf hcfikr *f cfi^tk «C nfhl anglca tu the Line of riaion. 
Due ftUowuci nul bo mail* for tMrvow&«n aod cmful wiuh b« 
kept ksi a acriouB IaII occur in aotne lUixk pAticot. The ordin^ 
Jm^i^ f«iJlii lo bt »fGrR<3 to itt f^ropcr cnuos I.e.. acute or cbrom 
dlaetM, fbx foot, ooiT]^ etc A lUtfng fanDord ct the body U norErv«bI« 
fa puilyib ftj^iuii, kyptioai disc to vcncbiv) av^e& aod ccrtaiD p»uiful 
■bdomintl ilfrrdrmi hnih ju-Tiir :(nd rhmntr. fjumuig bafJnovd or 
■n xtutl lt>nLjaiB any be due to spinal dificasc, lulvuiceii pregnucy, , 
Abdoieitul lurnon, udTs or obait^ and b u imporunT vymploai ol I 
psndi>-hyFcrtiXiphk ponlju and crcUDiim. 

T3W pill «/ tM4 dtosru Jf«r« ff/ Sfranoiar alax^ ia atrikmj^* tbc Ccct 
being niiMl fuddenUH jtrkfd iincrrtAfnIy fonvani beyond the ordiDwy 
limit Aod bcDUgbt down bed 6nl ifnib ftMinnp^ The patient kceittlhcni 
well ^Mift Bod mim k«ep his eyei upon tiie ground. Icei he aviy of 
rren Ul. A luddeo lurrtln^ iiii>veQiail or nn abni^ riftr fnim |h<- »ii< 
tiag peviun is lo him dldi^lt or impowfbk. Il must noi ]>c lorRotton 
ifaAt ■ ptttlpni laay ^vs ibe diseuc for years before this lypkal gait 
■ppe4n. but evcD ui vudi sMe tlie acute oboemr may detect lomc of 
t!» pcculuu feature*. In marked contrut ii Ih« spattiegitU char&cter< 
iMic of A<Hi«/Jlcf 10 if mtU^krul, ni taUriU tdirmU ifhUottft/t. Tbcri^ld 
leg mow ttttty. the i*»\ docn noi quite deir Uic ypound. necfMJIating 
a tildngur ibe prlvi» aI esch «iei^ thr toa ilcKTibm^aii kit ("mowing 
fftlt'^ftcdwconng down tlK tole oa its fmicr St^Ie. SpasHc €imtra£li<m 
of ibe addwtori •omrtimM pctxiucs s "'ctoct /fjj*d progreaion'* aUo 
Mcn b bysterU. Tbc sUppa/^t ga^ is mo«1 oftcp xen b muhlfilc 
M«riiia u A rcciJl of £>?: drop, because of whicb tbc [dtknt must 
lift ibe Iboi ta ru)c Ibe Uic clear of lie icruund tind tlic rtsuli bi a paw- 
bi|t novemnt tbc pslknt appcsring to step ovvr conslanlly recornnx i 
rbmtgh rim'^dslcnt otiHludcsL | 

Tb« Clioreic GoJI.— Wbm pnoent U Out of ibc xbool boy, who 
in Khf *rhoolmom ta»Mlocully trips ^wr Mi heel xn iiirut tlir Aitention 
of bis fcDows. Il b ttJdoca tUUAodated wkb otiicr cbai^tenMic 
^rmptotto. The w/ik^ goii tii OMVbcltu (vwrrtrB) InionB diOcn irv ijvf* 


f>« tains 







A banvd 





wtl«tit hw- 


Lit tlin- 

■oqiect Cnm lluU of 4 dnuibcc tnin- The waddUng fftit of pdeudfr- 
hypcnrophlc pAriJytu » due lo ibc wcskncieh uf [hr j^ulci muKlo. 
The p*1vb Anil hcfid ot iht itmsai an jerked ft:inv4ril M CMh si<p>. \hi- 
Hftt^ knrc^ U Aili-inrrd, <^xr<^n:tr<| nnly afirr rhr fvii U [J«ori| Ail 
upon Ihf gruuD<l. ui<l ihc paticni connol sUtad on IifiIuc. TEic /rs'iniMf 
jttit i> pMthognticaonk of pu^lysj* agitatii and tbc pAEiVnc «:iJkirg» 
if trying ta reoovcr fnim a tiinui from bclilod. iRjltios or fihiilflEn^ 
wiih the Ixtdv bent foTwftrd, 

InumJttrDt claudicAilon jind Thomaen's dluaM rrH-ril sjimBl 
rcferonce^ The lornK-r i4 amxiaicd vvilh iitcrb-oclt-nwis &nd dcfirkmt 
drcuJilian in ihr Lowrr limbs, chaninrrijvvl tiy numbneu ar /Mtt/ikf 
(Ydffip» on sUndiniBE and WAlkin^, uwdniKl iilh rij^idm. rh^c^lbciuai^ 
disftbililT. oftpa entirely abwni %'licn at roL ihc lalwr, Ji Inmdy tlMv^r. 
01 cliiLiMtcrjAcd by utillncu uf piitnlm itmintctitm kiri atU^niptiiu: any 
moKuUt actian. 'i'hi»i in wnlbing ux iiM fbrckb »r delays tndi 84qi 
but ^dtully wcarai away ojid i^trnJu ULirmul iirujcnruion. onJjr lo 
rr^ppcAr when any nc« miuclc lO^uv i» <:niicd info acci^ or ihc wiKic 
kCtlon rcp»(«fl aft<^ a rp*l. In the is^tf/r di^r^sr lUf fidst U uijfiUy 
abscfti trJr/u' thr knff Jurm^ thf tciinfr. 

Astuifl. — Ui^^dcly U jLkJid). AbOSta.- t Jtiabilily ht wiUk). This 

mrnt hf clasard ia a fuiidji-iiiiil rieLjru!»i!t iiusiiiuih a% oil frihrr nrrvoUK 

f nnciians ELTc nnrninl and thr picture atiOQ^y niflet^Ci hyiifrin. Wall- 

: injc may 1»- imrKrufblr >r( all lu vMwmMlf may he mirn^ally per- 

I fonnct) nhcD (ho imllcnl k lybiE m Wl. 'Vlxz lnM\i[j may be abntute 

or parttiil. givLrg rtw in what ^Eniulair^ ^pa.iiio paralyii* on the one haitd 

ar fUmdi:y upon tl^c ulbcr. 5iJtoA»ry j^jm a iatwiimrs nhsenrrcL 

' WEIGHT A11D H£IGUT.-£vrTy i]r>ap^9 r-ffioe ibould roniAin a 

pftir ('j' afdiraiF Kalra. aird u knmvlnlgL'of ihr weight, ^ff oflff prtsmj. 

I i> of ihc iitnw-il importonci? hoih in 'tiaifncvia. proxno^b and Inatmcnt- 

I In ^|em<ral fine mcnunien n irnfli*riL-y to incrraie in uvii^bl after Ifac 

Age of 40 awl <ifrp]dffu* it ffniimirily amtthUd ni'l* a trm* majih^ 

Uivr^. pMT rrtitt*iwt M 4f«V ditfMtf tt*4 a JfniUii t^if<fKy Jk> c^£<'i 

#raJ^ d/ Uur AnjrJL UolW vcudj finJ kitiiuvi it mhidlf agf. tjtrty 

Jmj of urijcAr U oiif <^( tbe nuitit d^iificanl atjcn* of incipient laber- 

colui* anil carclnrima nf the itinnurh ai wr.H ju marty Jiiherchnmk 

Ailmonti. Waittnn or rmdfMfKm » pn^nouiK-eii in ccriain dljicali^c 

diaarden. all t^trrr- <>r prr^lonietd fevcTA, trie dialiria mclbiun and 

llic varloUA waaiiiig d«ca>o of diikljtn. A ir/y /uiV niimtilfiii nrifhi 

ha Ml U mtidf by fin^iliKg tip <i UM o} tkr .'*w tKtr thf mpfff arm 

attd rtfiUng iii imuoiidfj. ia diruuit odiniuiiiig dtvaar* twi golj it 

DMcnptkm of Ifylk SUndard Table of Hclipils and Weights, 

"Tbr iboil Terfic&l liiM» nurkcd 5'^, g^. 5'S', and «o cua are Uv 
fadshi lina< The dUfontJ <urvril lii^e^ iruukcd x^ jo, 40. knd %$. 
an Ih* tfCF Unw iot mm; ibr linr» rtn^ignfttrd hy the sljtft O" arr the 
Dg* lETLiCt for women. The niLcnnedMLte Jign fall a( pra|ji>ttionat« dii- 
Uqco between lhe«c cuivcd Unci- The iatcncctkru of the age linea 
viib ihe Tertkml hctfihi Lhic« fti The nortiul wtij^l pofnEx The 
weighb «l iniofvftlfc f)( 5 pouAda 4» rocordod on the huriMnut Ibet to 
ibe dgM vf the diafptful cuncd tioo. 

"Thix*, B mwn s'*' In hd^ht thould weigh, *f *fe twenty, ijjj 
fovnib; At ajcc thirty, ijji pouni}i; al Ajce iorty, 1,40) pound*; al ix« 
fiftjr-fiiCi %si\ puuEulifc Thv wiri^Lta for ialtriiLr Ji&le a^ sir fuuii<] 
ai eon eip ooding iciennecliiif pcJnu 

" A womin 5^^ b heijja sbouid wciich. at aj^ twenty, lya^ pounds; 
Jtt w^ thin/, I37t poundf; at aictr Unxy. I4j4 ixtiniit ^itjc^ MJne u a 
«aii Bt agp thnifk^ A1 fitty-Ave \\\t wrighu of mtn snd women ore 
the «Ane. la Ifab wa/ «re found ibc normal wei^htA for any hcigbt oX 

" Nowi l«l ue ra[^)Ott that ■ man ^i^ in hright and tw«cit)p ytfin of 
ftp weicltf M5 pounds; hov much i> h< <>vc[frejghl} fliA norma] 
wrijEhi k ijtsf pouTtflft Priuhft fmm the ncimm! vrrli-hl point hnrt- 
MOtally tn Ihr rigH until u^ rnch t)>r ^prtK^l tinr mdrlci! ^5. wt 
fin'l ouiselvea ju3l milsidc tlr 6s per cti^t line; vudi hI pcraun is tbus 
huvd to be 66 |vr cmt orrrweigbr. Aglin. vuppoting Ibt MfflPghl M 
be 100 pound*, ve poAi IviriAiniH-itJy ic^ the left to Ihc loc |>ODndi 
vnticai Hoc; (be iour?e<lion <jl oui vtci^lii Tine trith il]E3v<itjc&1 line 
ikowl Mm 10 be fl6 per <rM. iinrferwriwH In the wme way the [«» 
CMtuflc of )knj ^ren wciji^i [ibove or bcbw tbi: DonniiJ muy be 

'The vrnlntl wfJ^hr Hnrc are 35 [vnndft apiTi. iHJt fAi prettier 
acevsocy the iaien-ninjE ipeoes arc diviJod by br>b<ia line* into 
f -liouad ntbdinuona* 

" Mbukn In (be a«e of the rhut will he ft\<dlded If (he rolloving 
fliepi Kfe lakvn b ?h«ir pevptr i>rder: 

" 1^ Fix xtpiM xAe Aei/Al line. 

^^ Ifl^cauisTtrymmkirmfr'arui»teni-tislti--'fiiusfv)TT^'niaMy 
ID fA^ fifkl i* tJU* tf ^mweigkL oad to Ihe lift m tatf cf trndenrnght^ 
i9 Ac iMBrMtfFM nilA iJbs tvrlKttir tiMa^ki tine. TiK ptnihn «/ IIU 
pritti tku f«vmi ;Exu /** p^ tad. ovtr^ or mutrr^itiL" 


TWi i;crrwucD ^csn ov DU^AAr. 



ihe Mn a nbfit bat h Itcka nomuJ dasiirtir- titertn^ it/ ve^'^ 
ordAArilT mdJcafc* no improvvd gcnvnl comllion and th« anvri of 
Any liic^ dJauffYlrr* hoi it muM br murEuhcr«1 ihjii ntema itLin intrmfts 
ii, and in BHithl'a dfwMC tif>ccUlly< [he vahjuion in botl^ wcij^hi 
miy rrv«al i hyiWmit nM i^tvwm Yty imtwunl slf^v Stt Ak) hifn r>f 
vrti^t may in Ihii an<d in curiae ^yi>n ot cdcmn be a moK fnvura]>lc 
flfmptgiB. Wvtgbl lav «]«rayt iccorapAnJA profuir diurMit, fw«ating 
iir (Jiiriflnjf CWAAreif sfuntUt 9k jvti^htd wttAly ani ihoM i^iov nn litumi. 
tiicrrut cil front Ad-dj grams each month fcir the tint four, frcm is 20 
grant for the fivf imxicilinK uiJ Kmicwh«t |t?» fur ihr rrn^RinLn^ 
inonths ol tbc fiiM jrcar of Ufe. Dufmj; ikt firti tiayt 4jirr Urih ik<y 
may tMom a Amrufrmdlc vmghl litu Wri^Eng %h.oM h^ don» «t 
chc aiQic hour b rdaiiao to ma^ in alt riArs aji J with the ttme amount 
oC di^thivtit a poMJble inawnuch ai the «ijmjii« of 6ve to v^s^m pound) 
<lor<V>lbt'i] :irtiilEV) ittaaEly mndr ir4iu(jijLM ti Kni\r error Tk< rriatiun 
^ kffigtu I* vox^f I* imporvni anri U well «h»wn in the iftblc which . 
«ppc«jtiipniithL-o|)pi»jlrr«igt, Th]»wrM|irc-fttrr^1bj^ Dr,0. H. Rogm| 
ftftd b Ufeaiouj and »ci:unic. tasunuict companks rcgafd wuh suat- 
p<ion nm whocc i*d|tht niiu raoiv than Mor*5%filyivctheftfAn<laFd 
tu iiu1icslc4 b; the Ubie ani) iliiil th Ii [jrcjudice L^ (vdl foundrd hu^tftTii ' 
ibcfwn by th« ivflulu of the reo^nt etombined oeliurlAl lavrwtiKaLion 
Mb&ch bM prnm a high moriaUl)- in thi» i:Ihrs vf tivr* The lAblf of 



It»r]>i ixif 




*• Ifalb^.. 

" alM^.. 

" 5 ■* ,,, 

" 4 - -^ 

•' « - .., 

»' 9 " -,- 

" 10 ■• .*. 

" ti " _ 


'■ f indi .. ' 

" airnhcv,. 

'* 3 - ».^ 




toy p«i«Dii4^ 

tOQ " 

H3 " 

115 ■' 

lift " 

t3» " 

I4> " 

' 146 - 

150 *' 

ifS " 

! »6o ■■ 





<T4 F 


1^1 poundi. 


































Pcirvoanorf nwUbrHl | t«ib(id for c»;h > 
tke rcnill viu b« iho Mrmti nnitht for rhc pvcn 

cv undrr tottf^cfttk. and 

■ SM. -Ig 



IhtVUtm •it 




D. H. WcUj is Ala> ^rcn uid jft an cxccUcut one tot pr«0ic6l usev 
[A ronn^dion with u«Jfm^fA<r > fftmily hlsioTj of tubtfculoiii OT 
pcnan&l biBlMry ijI pfl^t infcclkiD, & luurovr <l)C9t> smaJI bcut and tbc 
evidence of poor drculaiiqa ore «xtrvnidf importanL So ftliD is 
otftmeeighl one musE disUnguish brl^vrrn Uuwc who have big hnncsL 
ttnn well developed miudca uid modcntc obtkxniitA] j^irth n contpued 
vjtti th(^ llftbb^'p hlft bcUied aedcnury llvcnuid bctvj mffn, fiftrtlc- 
ut&H; if Ihoc hurc a fomilx bislorj iudicaling an tcrcdliUfj loidmcjr 
to Lpopl«xj and diMUM of the heart and kidnvjv. V^ry taU. Um^iw 
fMv, ^aiUi and ^ejeiiiomU iUhUta art not tu a d<us Um$ livtd. 


AGE.— By practice lAd doM obMsvation one can uau^t estimate 
dosrJy lb« age of paMprits, Ihough liltf the crnius muni^raior he nay 
at timc4 in the tiutf of ivomen be abtiEcd to anept ^Ulemcnld with 4 
mental te&ervntioQ. The esoctitial points are a^pareni as ci>mp«i«d 
with actual ag!c ind unduly rafid asing. Ceitaui a^ca repment ■ special 
prc^blKuiLon (o tcruin <iijeaM9, actilc and ducric ^n infancy omd 
thiidk^*^ VIC mipci fspKially whb acute digratiire disturbancet, ricfceii; 
Ihe eunlhcmata, ulTcctiona of the IrmpH sln'id*, racalngitli* iiifaitdle 
paJaicfi, thorcft. croup and crelicifltr. TuberculoAi atiackft the youog 
with an cfpecbJ frequency and a fainhcr niorlaliiy. but in those iiodcr 
the ngc ot puberty ii I» peculiarly liable to affect tba lymph gtaod*^ 
paiticularly Ihou of the cerrical trian|^u or abdnrntfi. During adoUs* 
MMCff. ddoroaia, ran'ova forms of hyateriaH efulqvy, acute rbeumaiiain, 
gaatric ulcet and tuberottoiiK ore excRmd\ commi^n. As mid^e a^r 
of^oaches llic tendency to the rjta^i LbcuuiU uid (ij diule hfcctb>u 
generally i«dimiai<had and a pEvdutpoitition to dr geH«r>ti vb liioeaaii <4 ^ 
chronk type appears. Such axe ar1rTTo-4L:1rmftiFL iiiyucjinJitI&. raJvular 
dtseaacj, gout, gall stones, diabeteii the injuniiira. varbus Fonna of 
par&lyais, profound blond ditnirbnncAtuch a« kuko^ia nod pemfdoua 
anmua, carcinoma, chronic Bri^lTs dbcaoc and a^ibniv In M 
agt, this predlapoflCion of niddla aga It, £n ctrtain ccndltions, {nlvaid- 
fied and In aJdiiiun kc (lud iJiualalic disKiiM't {.[iruiiSc bronchitis and 
emphyveraat and a return to the cfuldiah tendency to broncho pneu- 
monia. In sKtmc biiiiincrt disciaa arc wholly limited id crrtnin age 
pcfLods. but UBualty in wd^htnK dkgnositi'c probahiliiici the question b 
one of 'vtovw frequency '''or r-iample, canrer ci thf itomnch h aa 
inie in a pei»n Limler >o aa is miimps in one over 7a Rapid sK^ng may 
bring the man of 30 to the none Htaliu as the one of 70, and on the 




olbcr band Ibe falter, by nnton of inherited vi^or of conatiltitooD &nd 
rifl^ Uring dmj be p^TvoUj 3^ ye^Ti under hh Atlual ap. Evcry 
cUnklui Rpefllcdlj ciui^untcn axi of mukoi oftcrio-iidcriaHs in men , 
uadcr 3» yean of ajeg. Htc mhcriunn of focr itruciunJ mnlerial, db- ' 
•ipfttkot, ftfld mmtil vnilD itrr th« r-hEH fnriorq in rariy nielng Flnnlly. ' 
o«e snut rtfflcffibcr l^ <Sc^ '>} af< u/on /irvj^om. The acute cx&n> 
IhcnufM Ibou^ man rvdilf 4Ci|uii«cl w for \h/t munT part mucb morv 
H^idy bonr by ihe diUd Qua by tlw addE atul nsutoJitc Uk tubcroi^ 
b mudi mc«v mvietl ia pcnont above tb« ai^ of jo, PntniconJUj 
at p«ubf1y (aiaI «i ihe cjcLrcnici ot Mir. »nd the yrmfif jj^fJ ]wiiple , 
stronidT rcaial tbe adraiacc eJ chronic dbcut. 

SBX. — In gmenL fnni and nromen fuffir about M|ua3ly nn.l mrst , 
in abovl tbe Aame measure the largex amitbcr of discax^v nf^rnlhctcK I 
there are ecrtaia slhkuijf di0«nQC(4 boib ju 10 incidence %x\A (n«riiy. 1 
A» ca(n|iaitii h^iI) men^ women, Lhi^>u|cli Ihc dEabUitics (irculEar tnl 
their mi^ *PP*Br C^ dovtdop tupcfjor vndunccc panJculaMy nirkfd ' 
ki dirooic ittacMT The womnn n prjfcially liiJile lo rtf^urssihf^njn. 
hyilcruu BonUc ki'dotj. mjiirddHA, arlbrids defomiAn?!, <librcMi» 
tAd ch/ooic Mcondafj aiMraiaa, gaJIMont«,]p>iirevcancrrof ihobrea«L , 
and gulric dter. On the otlict Land, she almrat oenpa liKiiJojiliItiH, 
■AMBtea and bcoRWtnr alaxia. and ralTen Iota oftvn than the man 
fnxn acide infvrctinnd, |;nul, iipprnrlidTii. i)phoiH frvrr. cenaJr disRUn | 
of the beut, profcre3»i\« muscuUr atrophy, ctubctes. cardnoma of 
the tiooucb and Iwd. InjticmiA, pfmidoiu ^niFmu) and AdHlson'a 

JUc«^ — Th* Bp«dal preditpositiim of the Hehrvrv to<liabMMBDolhlui, 
of ibc liU to lubvcubHSi of the En^l^h 10 <^u\\\. uf the cunimcfntJil 
mcci lo ukhie. etc^. elc ii wetl knovn. Mc^ovrr ccrtoin mccs ihow 
ndKrhedly grmlfT mhujan to dlteue and Furginl pram^um than 
do others, 

HABITS AlID ElWlRONMRirr-TTi* lerm "hihtU ' ahould 
cvrer a bukIi iuger 6cld than Lhe patjeol*» indulKnice In toba^o. 
driigv, or akoholicn vid indudc hU mvlroniDenC &nd mode of lif«. hi» 
boon for mob and tat ilnrp. bji mannn of Eating am) the nniure 
ol Ua Bcola, do kw Uian the crieni of hb dnnkinf;. One thould Mk 
vpedAnlly vbai wu ukm fnr linxikf,ia nr hinrh prrrrdlng ihr timr 
of cfac owmoatioD. or just Hhat b uMudly taken at MJth a lime, bow 1 
Bucb wvtcr b dnink and wfa«n. bow miidi lime u lak^n for tbe raeai. j 
«rbcthcr Ibe (ood n |iropcr)y maalk»tcd. and indee<] osixrUin tbe am- , 
dition of the Iccth by direct inspection when cvoniininK tbe ti:tnti;uc and 



HflUCAl. mAoKonK. 

Ir< din 

ilm«i TV «uIhor b«4itw> tbti loo inudi iiRu if laid npod ifa« uw 
of IcAh oilln juid totucco, and Iim Ihtlr u|jon ilic idicmTicTajiT oi the 
p«iicrtl in rtffifd to Ihoe «tlklca. Thai vrhic^ mn^rifutM fxre*> far 
iinr r^trr vim ovdmtTon in anolhr^ranrf eV ^!j||!}]| ^^miiiiTiirrpmrmlnf 
iht svcraKc ren^umptian can ordin^til^ be of little conscqucnoc; hcrcr 
il U B posittrr hardship tit tifi>iEmnly ^ul off nihcr iliin fr> wiubly 
cni di.iw» Oic Lcii. coffcf ttr tubActu wItiiJi fbi yein )uub l>ceii the m>Jjkc 
oi fomc eldcriy [latirnt, A« ni;^i taA^at, cspMulJy. one mav Bay 
thil ihr hi):n* <«* in^imiuixnu^ arr ffwinl iit unrrfrrdifniE ^Wj*, fiinnl 
tovftui^ anil bad t&ste in the mouih, ncnDUoncw wJiidi Ijike* the form 
of menul irrJTftlhcm and |vTfaft|v tirtnor. Knd at limr^ a disrinn iliflufb- 
ancc of digalion and imtxliJItt^ m jinlj^lntJon t^f the head- Im ibe 
man und«r nviddJe nj^t th«c «ympti>mfl nw&n iiltic; in the elderly ibhi 
rtiiuh. ftnil £ir ifv liKrr, |<-nisirn(T in etc«w Ift fnuKtit with tknj^. 

Tli«UMof AltohoL— 'llic CT>nvnv>n mittiikc ^f ihcnovireUftfni^vn 
to tiring tnix tiULii\i\\y vvr fully ihc fnm Iwanng i]pon a patiFnr>t alno^Gr 
indulKtrtcv. He j« im e^^Ily mibfied when the potKAl uya be "ilae^ 
not tUink xt All," or hr "Utn in ocr^^nil firinb." or "not onoojih 
Id hurt hitn/' "u Jrup now and ihen." "jutf anoftl glaat.'' ck.. rtu An 
&b«alulc denial of oven'nduig?ncc ii luimlly prouiUy mndr by (he nnn 
wh» h** b»n fl harvi drinker ff*r yrjn; bui hw sToj)fjc-l, ii may be 
only for * fc« tUyx Tlic ''no* a»d llwn'' kim^. -ir tboae who My 
'*ofirn ni>t fiiT 1 }Tar/* fftiqu^ntly rf|ireveTit Tbi.> wnn^ type of >prw 
drmkec?- One ihould inquire therrfort abuui the pmtnl and ibc poA. 
the cxtcnE. the boun, the kind, in nhal ntblkm lo mnls and wiih whit 
alleci upon the healih- Tt h jmpnivdblr m lay down nn alunlule nile 
ju to nhit oi>n«|£tute> cskca* »hd it ii |irol>n)>1c tVinl ihc mm who l^a 
a liirlr 1lr)m>f, r'vrn ivo or thrr« tir>r4 A dny uWl r^iluird nn<\ on a lull 
i»linnflch. raaj suHcr liide ur do bad fiTttiA but tlit Amcrinin Biyfc 
drinkmjc ift pccuLiariy bftrniful w takinjE the form cif "cocklnils" 
meab. and a |M.-mIdikiu muUifiKcJty cnKendrred by the rUKlom 
**tmtinK," The three diicaxa aioaf oftcit du? to nieb o^vhnilijlfcetioe 
an:-^driinvin tnrnrnfi, alrohrAJ^ ni*tirtfl«, and rinhndi ni tht Uvi^f. hui 
ii u a poTTcrful coQtribiitory tticbiir in an cncHrmoUA nurihcr '>f tbroiuc 
dueLw«. iPTiting and promolung llieir devHr>pnvnt *nd h^f?ii'rnlng 
life and In ncvcre acute dijaeaicii audi as pneumonia the iUuDkaiil 
iUn<b TiltU thcHF, 

Drug Habit. -Ai rrit^inl* lUtr u»c of ilnijct, we hmc cKii-fly (ti dc»l 
with tht vaiiotis lormi of opium and with rocnine. Neither producaa 
in eveiy individual a dear and dedfiile ^yndrtuni' bni nnr of thf poi* 



Duuy imEoMieffls li a prcuUnr umrai inatibHiij* or a biffing and 
bttMard vympCoB complex. A nurkHlT dilnicil pupil In cocnlnc 
Bfvrt nr i nurfccrlly coolncied one lit (he victim of ihr nplum habU. 
rmy tflr^ allciitiuii, IjuI ia cllU/er al the timi? t>f txairuiiaiLcni (he (jupit | 
nuy b« oofnul. If <in« namiim ttich paticrits l^ionnigMy. h« will | 
fifun A&d rcccfil hypntcrmiir (mnnuru. Htcl i\ois rriimvniins cild 
VOC3 or cvidoicc cf leccni of old multiple 4l»cc»cj due lo (he ux of 
dirty Mvrilo. Soch arc Dfuflllr on the rlf^t lhl|i;li or lell ^rm nf i 
right bawkd pcnoU' asti the needle u usually iiitrwluced <tiric< Ely ihrvu)^ 
the doliiinj{. Thv peculEir pallor cofnciimn pmml hai b«m rplerrrd 
to. the ikie b b1tdy id he dry in marphinr uurt^ liir aitprtiic pnot and 
botttia oonMtipated and itt tkiim^ of dtter dniu are subject ld 6u 
«f profowkil deprradrvi nutvrciecl Yry poriofl^ of hiiriVRnry. ^'Niw , 
nibbtf^i;'^ may nicpM opluci and In ibc tnst of choline uaeis (apeoally I 
fonnkatioa i« nol an inlttqwnt cympiom. The eiceniw use of cocaine 
may be banentljr denied hj one whn hai ounlracied ihc haljil tJiEvugh 
tbc use of the dni]{ in Ibe nual paattLfie or thnMl. and (he author hnf^ 
vaoonitiend many wrh tvm. lht^ pai{#n> nnr mljrfnj^ ihsi abvorprlon , 
lAkca pbce » sudi ioESlances aa readily a^ if the dnig wvrc actuaJly i 
tak«s into the Btoaiadi- The ^^pnue oi such drup m pcvrjinilid may 
boCQCVr a lueii habit arkd Icmi to K^noui tit even fal^ illnrM. 

HARRIED OR SINGLE. The ti-icKt-on of marrkj^e It jtnporlniil 
cbicilv iu rrtaivMi ur iTir ninllrf i>r Tirt'^tttmy 'if fhlldbe«rin^ in woinni 
wid Ha after efiocti. Many obtcure ailTncfitu in the fesrale are traceable 
M unrecogDiBcd or ne^ecteil laceraiiont. n>iilc rndoTnt-intit. (ilrrinr 
tHrfJarrmifiitfi ^wlrfc abtreM itnd ej^jthelinnta arc c^t^iniAlly cnmnii^in 
In nuttipane, 'I'bc niimbft of prefpiandea* the dnntjon and icvcriy 
od Unit. ini»cxrnii|;oi and tlic urcunuitancea atteadinj^ Itirm. the 
mMnber of cMdrec tmni; and dead, the hc^ih oJ sumvor; and the 
enow* o( doLth of ibosr ilMie«e<i arv important- Itari* of ijphilis 
in a fhfld id)ou)d ai once diftel nlicndon lo one or hniU pareria and 
■rkie t«na, and tuherrutoBJ* and other ditn&e« may be sugf^flled in a 
similar fmnncr 

OCCUPATtOH. —The occupalion and <!nt^ronroen1 ore importnnt 
Ijifdan in dfaRpcnis i^d fmgrtcnii and may thrmt lip^l upon dt-gmrT- 
alivc pmneMtx fundwfkal and oruurt^ nervoua dlKnac and aeddcnti. 
City direller* and (;%dnor v^irtc^ tntTrr enpcc^alEy from dyip^ia, tubf^f' 
mloBta, nmuatfthcnai andainijJv t\i»jrc\m. On the other hand, rtcn 
tht OoUftHy dveliCT and out ot door worker aut safler frnn the ponr 
mulbubx) aoJ di&icDl ainitatnm ta be noted in many tann tuiuacL 




hdtI <hi|ij- 


Can nil r^ 






So tin miut 0D« toondcr the «£c<t oi ucutinl cx3>mu]« Io cold, wet 
vui u> «udt poisQiu u nulada. The bcM condiiion* aic lo be found 
in C4mp li£c or 1b« hotto of lh« better cUsa cF a^kulturistt, tbe wcvfJ 
Id ihf llum^. rwMt ihopA or iospioperiv renliJjiteid facloru* of grvai 
dfiee. On ttc one hand there a the mAxiitum of fresh air, sutuhatt 
and hcolcbful ncrdscn on the other foul :ur in the ihop sAd home. 
comUuti cateniiK t>J tht unic ciusclra ami In narii|jcJ iJCKiltinnA. «iic] 
u ft mic decent or improptr food- Certftin ocmpotiona inrolrlng 
the continuaiu me oT cme n«uro<ni(ucuW unir pmdure ipwifi^ ulmmlt 
M do those mvolvinu preuurc. or irriuiion of a pfirticuLu portion of 
thtbody. Cajaof njBiftgmuf haitf bom njvrtfd tiaflMt to Uie crBon|>cii 
jxaitiua of [uincrB wurklug with e>«3 CiJct^ ti\nja i pditicuUr puanc, 
PcniDttn't oamp or acrivoner's palsy is a futiiiioj rxunpLB. Ui^ Uic 
rhmnit kty[i|{itj;i ol mJlJuix men. dcrgymrn. mjdionciiTt tnd public 
^pcoken faUs under the uime hpctd, Anotbci euiuple u the uiflAiDaM' 
iLon of The pntellBr hunu, leii^'VTi u '^houjinnAid'H Icncr," ihft cnndJikiCL 
bdag cncountrrcl aint iu ruof ihiri^crii die layers dJid ollirra wrorkunf 
ucdcff ftinuliir coniLitionfi^ 

"Going to boofrfiriE BchivJ" la one rj the worM of occupBtforn li 
tbc >cboo] irork i* ovcr^hard. tlic be^Ling and ventjl&tion iniufhcknt 
the f<ior1 poorTK prepared or bcking in quilftj and vatfietj or fhr out 
of door c:*crtiac atinL Noiliing bfiKtla moft chlon^tics than & poor 
boarding tdiool or mxkes h«aUhicr vomen thui doe« a Kood one 

Habits in ReUtJon to Occupatlan. — Tlie octsslve \itc oi latwt- 
imnt^ t^ ilrfiTi^Etiy rektcd to certain calUnt^. The mano^r of o lar^e 
holil ^u '[[< iTf^ ha« said that he haft yei to lee onf bir-keeper whi) 
failed Il:i devcbp the drinking habit, ai>d this staiement undt^ubtedly 
cxprettes ft nile subje^ to few exceptions. A ini^clLiifT rnAn «rba 
trila hit wiyi'Mff^. «i>^j«. vt evm miurrxl iftivler>Ia rumUiitly uiLjccled 
to a prossurc which too oftpcn resulta io the fonnation of tlio lii|UOf 

Occupation If^ToIriox Contiauoits Mental Strain.— In this day 

of gnciiT entcfjin«4 i lar^ [jfupoit^cfn o( ihc rJiii^nic ai-lmeou encount- 
«jcd by the phyaidoD may Irr Imted iii wbde or in (atI to continooiu 
mental ovrr-itrain. uauolly combicetl with lack of axtdat, Improper 
diet and ion oftrn with over-indulgrmr in llqunr or robafCD. No one 
«ho h«« aeen the rccaarkahle impmvcmcni in chronic diurdcrt of ihc 
htan Alomnch. kidnej*, or varioui dISMAta of ihf nrrv«>ii& fivsirm. that 
fi^lowa a prnod of comi^tc tot and tnoSam from worry, lan doubl 
the polenq^ of nervous strwn as a factor in the etiology anil pvc^ofia 



at dhnsK^ R^ilnttiJ nicn,. fuundcra and capcdoUy bowd of tmk 
opsalion «ufl«r pMUy ttom Uil» aiu«r. The life of a pnctiaii|t phyt- 
idan to ol such a nature ia Io mu\S\y rxpl* in ihc hl^h cvly modality 
CBomoiertd in tlib due^ for ul tlw phrndan'A calling an combined 
ile&ieiil and uttcrrapted aUep. lack of fxtrtae and rvcr^alfon, txrtwivf 
and oMfamooa venul »ti^n. and a large dcnund upon tlje km4ljr 
ano<iou •> consiantly appealed ta bj hii cLtcntt, 

MIlMn] PoboBlnf.^A complnc vcilumc wnjld t^ ivt^ulrcd to do 
juticc la tliia aapvct of ot£T topic, and (Jicrt <ma b» no doubt Ibal loo 
Utile artmikm ii jiald ta ihi^ pnoitiLUTy of ocrupafkmol jioltoning by 
pfajskiana other thxa thwc pnctiiing iq Urge man nuctuiing centres. 
whcR th« CDOditiooa irr cxccptiooalLy fitvorable Io the development 
uf occupaltotui diacuca- 

ArHOic.— Aaida trom poiaonirig duti to the inhoJalion of lunn or 
dtttt ihtrin^ ite p ro f M M M of nuDrng. grinding aud unrkJrg on« «ii^uni- 
«n cajM aowapt ixskon £ii anilme dyc& toy or arliScJd dower rrukcrv* 
dyva ol wculen or miiAn g^wMli, plajing mrd makf-n, luidrrmUu, 
lltJM0»phCE3 auiJ »h(jt utaLcn 

ABittoi. — Hut ddrivea it» bamfol effect from ifart« flourcea vu. : — 
ttxflL die anenk often camtdned with \u and tho ahn>4)cn>iol uied fn 
Its BaanttraaQre. 

Bromine end Iodine.— Th« fumtaof thU tuhftiancv catisc bron- 
cUdaand prodbpoac t<j tubcccokob^ 

CttrboQ Biru]phid«. — I1iis highly poiaonotu iiibihuice 1* luvd ai a 
lolvmt lor nilphur, iodine and olIa and £a lar^j used in the manu- 
fadureod rabfcer jgeods. 

dilocliie.— fn Ihc blnkchlng of Unm. rrnon, hnnn, ivoiy ami rage 
the huM» arc tiritttting to ihc broDchiai-inucoui Eocrabrvia and 
pfvd^wee lo tubernJoait, 

Chrominm.^ThU enters mto chrome yvUow and chrome gmo, 
and if uaed in ttaining t^ua or porceUinn prioiin^ boiik nolca. tttf 
dyeing Keen, woisJ and lilt. and m pi^iaAsJmii !>i(fimnu[c £i uwd in 

Copper. — Woricffa ir braaa, aick«1 plalrn> br.«rm<n, copper thttt 
acmpcn pin wakax bdl metal workcn. stone woritera, engine wipcr>« 
and otben haniffing copper, broaie. biaet or nickel may aullcr from 
duuefc pofaonbtg. It abould be neaionbend thai bna U <i>Trt|xiH?d 
ef copper and sine; wllb or without tin and load, bronac, of aU four 
RXtali. artd Vhar nickel plating la Bomrtimce done inih an allay corapoied 
of copper, oicfcelt iron asd tin. Ii b funhei oomblned aftcndtwa 


usMCAt PiAoitfoem. 




Willi h»d AAd AOenic. One ot the moiri vrrcfc cub of kad inooni _ 
rvrr cncDunicrvd by tfa« author wu cawd by pcUuidnfc &n tJloj ol 
ihls kint^, 

LcAd. The potability oS Icihd poiiipninj; in ob«cvPC ^utr^-iakstio*! 
iHficTEoni tft In mnnpctian wiTh it% vpII known nervoiu numilslMJowt 
should ncrtf be iotgLtttrn. Not unJ) ijt it fiiund tn lead smehcn. Rfincnij 
fihect-Ioiid rollcri. \va*\ jiipc nutkcn, 4hoc makcn, nrpc-sclicn* 
wy ftixkvrf,. and tminirn^ Ijul «hi in bittfurr pi>lt?UirrH. gildm. Ii 
m&nMl woric^nt i;luinsH aM |x*l. pM> aw!, cartboard or brick makoi. . 
mtkrit i>f bn« initiramrru; fili* cuti«n. Him j^mk vtorlErrfc wnrt^n 
in vhitc ur irtl lend and lilhAricc, calJco prinlcn nnd Unuc cng^gisi tn 
the mtnuliulurf oi Uct, iniDciAl Howcra ofxt will papon. 

McTcuiy. -CZirxrriit ^iLi^tiunAl jjoisuEiiiij^ cuy rraull from idiuei)naaai< 
krag ^ntinurd over 'liJcai?*. (ir employment in «ni«l|pn. c^oick (ihvr 
mimrf an<1 k-liinf^ momx 

Photphcnu. THi^ a nnv, ciMrpnratively mnc. and U nlnwtri «rt»all* 
LJmiiri f(i th'>fl^ fvijfuj^H in thf mjmufarmrr of thf [artnr ruuch 

TurpVQtijlC- — Sjieil' prrvjiis Jirr jinuliarly iiubjr^:! Ui ttiryniUnc 
pouonifig, and poinlm workini; in poorly tmcilaUd twima mn^ bccnnw 
chroni tally ;ifT«'n-<T 

Occupations [aTolvinjf Exccuive Heat. Kitrcmc <^ heal cut 
bah*imr Miihimt trfiowa rowtlta inporii w ihuhttnfitiHl, ncvc-rthftkaa, fr^ 
nwn DEI utcan aioicncn or naval voack and bnkcts aufcr tivm licsl. 
movture. foul air- and 1h? vffect* of chill and expMuiv due to cxinn)* 

lam|>rr;iiurc v^riuliunv 

bTiflCCIlaDeoua Dincnaca of Occupation, \fiikn. poikr«. file 
niiLt-n, i^rindrrA iif rit^l UvAh. «ih>1 ^rirl iViirtm tfiinri^iv mJirtilf ami 
flConccmtcnan: peculiarly BUKcptJbk lo mbcrniloaix partkvlaHy in ia 
fibroid form. Hindlcrt of r«p aod tkina occa^ioDally acquire ondinii 
inicmal or cxtcmd, FcitiEde domcidc^ an pcculiiuly Liable lo ana^la. 
I^^ric ulfcr and rLibcrcttloab. Butchcn or Jibu|tbter house nirn tuSci 
from itr(>[ic inriiiionK ^TiSErinrn from Irtajiua and ^Mudm. bn-ttnrn 
ftsloon-kc^pcn, btLr-lcndcra und others of the nu3W clasa show 
«normoiLt mortalitv ^m almhclijon, tubcrtttlotii. ductuHofthcaefraut 
lyttnn. ]jnciiitriinjLt. ilt>m]i« -jI (W liver juid kidneys, and Mkidbi 

OcGUpatioDal Stigmata. —Thofic wh^> li>llov certain occupailoa* 
uftrn prrviu >< I'lii-wimi rliMmtrriftlEf dcfomiUks: ihc Imveml ahnulte-' 
of the <Jcak worker pack pcddtcr and tailor aiv bmiliar to t^tryo a ft 
ftw railroad imJnmm rscaiv for lonf; wiihcul the Ion of one ^r 

FurUiFfinocT, th« etudy of the c*dUM>itt asti'ci4teil wttk <i^tain ' c*Ui h»* **. 
<^iUMnfr viAjr ai time* pmrc lic^ifal bo^ in cliaimjau utd IdcnilficK- 
Iton. vid t lev ol the ooeUfttlioftf thiw flUgfE^*ietl nrr hriflHy g\v<n 

Bfliij^, Guhtr aad Harp P]*ren. rn^^r iip« both hia<K 

Zltbfrr Pifijriv. -Ffr^r (i|^s if Mi haml un^rr surfi^r osd tip« of 
iiickn m^Mi and riiii fitii^t i>l righl, Violicc^flo or VtoLin 
Pta]rer> Tipi cf iing^rrs. Hi handotdy. Compositors.— sur 
bicc of ttnimh Hod tnilri ungiT. rii^lii liind Peoctng Habere*— 
Ulair bonder, rigM pAlm. HAad-or|taD Mas. Omicz lideol ri^i 
tiifilimt Ihij£!v, S*»msrrr«pf*, RjniKlirn^il r:i*tial borfW cif Irrininal 
phaUnjea of Icfl tfiumbnod indc^i^ Tailon. — Ktnfrabipcilalloitton 
ftgbl Ifautabin^ index finjier, Irft thurTt(}Dfidiniinruu|{heficid,«n1u;ii«<i 
buruT ovTT exlfnul niAlleoli. Tumera. — (^utcir tx-^dci nf rix^it Utile 
iact^^ Ckrk Vting Pen or Pecci), l >uirr surface u4 Ecrnib^i^l |<i^nL 
rig^ IkDr fjnfocr. Tti« Rough Callous Hand of Uic liny Uborrr 
coftlneA» shorplf with Ihri Mti linn<] ul ibe ntdenlary vrorkcr <m 'loci 
tbiit of the Mwnflms or ifrtmiMk' with ifuwe reprr rr fitinj^ thv lighter 
occupaUon^ oJ htr mx The Ian oi the lafUir (unii4>tf< >hAT|d> wjttt 
that of Ihr Aoldier, U>c ouc «re^£nn|; hU ftbirl ijfK^Tiatilio IruttL, fiirdth'-r 
the hig^ culloT. 

GtOMFBl Comment.- H'ant ai iKcu[>atian ia oFc«n dclcicrinu^ nnd 
ibr nmndlvBlK an^l hnfrria. murbji! irritaSihiy tnd mnui of a ^rriain 
cIaai olwomta tic rarely *ccd in Otc hardiAorkm^ bouAcwifc- njcEUAii 
who fciT JW9 ha» givrti hb atl«nifart lo active- t>tihiru-vt i>r i^rofi-uionat 
Wirt VQty Anil annjiktc idlciicM TjotJi Lnnrvjirtc ijirl tlanj:i:K>ut irid frvr 
aicn or woocn cut he wril iriwtaltf or phjrsictlly wUhoul eocne dcbixiltf 
occufttilan. and nrty man wfiu In Uicc yi^&n forakra hi» lifers work 
rimvld culUr4t« ■ fiobby or divert him-vlf hy im^cl. 

RBSIDEUCE-— 'Diet aavke irt*\\icjittj iaUs hi uxurv itic fult nAinr 
ttmJ pmul tiUn^aa oJ ibr t**tjcnt unrkr ciJimiA*ticin, foriECltingc OijU 
future OMummicftttOD w •MWtlOkU loutt iri)>i'riaiii hi lh:it ton? nf 
iha man valuable Infunnatfaa canm frcm tli? fQllqAiEi^ irj> nf uumual 
^^b(L MA pr^fditt itnti p4il ftsidtrMf sfwM te kitifv-n. and in 
^^Bnal fnflnmatlnn ujvjn chk ujhjf^ri it of mlur m rrki^rm M ihr 
pottubk: introdactian of EpidcmJc diaratc bj pcnon* camini; frjm ui 
infecied Mea. in Irtcinic iladittribuiiort, at hi j^n <-j:i1drniic nl rluilfm iv 
Ijlibald idTcclint cctiaJn ponbna of n dty ur lirutrr d&slrki- in (ladnr 
\iA iivdividuHt biiircw af iifi^iTrniH by Ihe i.H^-iion ol titrflrv^ 
^kymm^ whv •pnwl InlrctUin alun^ du^lr rou^c. uiul fuLdlly. bccauw^ 

Mlcndf ■ 






Th* horn: 




«f X\ije ipedn] liability to ccrlain dufflurs in ilefinde dliEiirti or countrir^^ 
u iltu5tratcd bf the dweuca of the tropio^ wch mt mAluid fcrtfi 
dcnf[Uc, yellow frver. «nd plAfpie. the hivlittid diteii' fif the ]erl«nd«f; 
Cot the krpnj&y ol tJie Sandwidi Uluiiltr. S^icuik iiufuip UHiiotiuif 
ibt CAiCi KilunlioQ of the patienl'A buuw, its eirtittion. cvpoeurep lite 
dmactCT of the siinouTiding vil. 4nd ihe bcadoQ of the sdeefrinf 
dumber, u often tmporuuiL 

?AUILY HISTORY, -rA« ifanmAsahn of tfi^ial j*vfJw«l Ml- 
' ntrjbiiiiy and predi$pirnUM it jmI at marktJ «aj 4U v«^ f r g »wi M 
^■iA«riW iiAram in Jom cv /MJurr, and In t^ing ■ Etnuly blrtoij,. 
one ahnuld aecutt fulj mfnrtnaiii^ u Id the tcmitul iltDcsae^ of tMttMjf 
membcm often jcoinft hadi two jctiemtiocd ood tnchidinit coUftt^rab. 
And cd ihr mstp fit hrAlfh ot niij« nf drnrh of (he hiubduid or wlflr of 
the p&iicntH &nd the cKilrlrcn, /' if irAA>m auficiemi it ^k n^h^iuf 
oi9y fwmbert o^ J'lr fiamily. immtdtctf iv rm(ti4r. ^w mfitftd /m< 
toviftfor^ dhLmut, of evc« to ptU ikt qi^tOkt^ m AW ftrmttrJui kmm 
tpfcifit jerm 0} an M^n^ OMfmviMf MitathHs <tr (diifcr. ApopleBy. 
hran rtftTMMtf Lir Kright'>< etfanMC nwf he rvnillly ;tillnfUf^L hitl fna^nny, 
cpilcpay, lubcrtutf^JA, ojvi mallf^unX dbcttae urc ofEcn conocfllcd, 
either inlcntiofiAlLy or innotenil)'^ The f^nestiou mud briag out the 
tymfkfmi of the Illnod'::! of iAtai\y mcmbet^ One may uk if ihttc 
btt be«n chron;c cou^i, Hpitllnjt<>f blood, cnuditkA. nl^t 
(ever In « gtvm oiae, or thr u'lnif jnf; oF bkiod, or the pctoencr of a 
auomred irith emiciatioa xnd UUng JlRnffth- Dtaihs from "child- 
bSrtW "ahauiHian." ^'gricf "hroken heart;* "gcneraJdcdinc." etc, 
mual never be Auceptetl withnut curcful vid tactful croM exuulDation« 
"Senility" or "dd *g(f" &rr mueh «bus»d Eermt %n*\ in th« lay BDlnd 
cnay n^ver dearth «l any a^ above 50. No man cvn (mjopJ hist oovItiaM 
ai a case-taker, without Mvicit horri thinip of ''moJaria." *'dulb,'' 
"fever," "decline;' and eiipediUy "manumui" and "don't know/' 
and no aiudciit can give bcilcr CTidence of hia tkilL and taa than b 
fuinish^ by a full and complMe family btttory, 

AItenifltiv«a in H«r«ditj.— Few dinaao are diitnly tiansmitled 
aa such; mbcr doa heredilai^ influenn take the form of prediipodlkik. 
Thu» the diffii&T of the descendant may he but the ctingener of ibat 
of the foflxar andaasueh k Icmed an alCmwiKv, oe. (he 1abcfiiuc« 
may b« that <if markfcj vubMnhflfty or its nppcolff. InvubstrabUO^,, 
To the foimci dan bctonp the "abort lived fajnily.*^ whoac ramdicis 
show a iow average life time and a ready a<:quinrm«in1 of and itMt 
maiAtanc'C 10 acuie or chronic aJUnoits, To the latter appcrtalru ft 



vigor of COEUiiiulion And fltrcnjclh and liumony of stnicturv whttli 
ouuRfl RBtsUtttB to ^Smtat &tiJ lon^ lif^. 

The )f<rrou« SyVCcm iA H»r«4itT. -A ifnmje diffrttaiive rtl^H^ ] 
gjeittt kt tiaM m ak^kittiim. inMmty. epiUpsy. hyu^ria and crimmat ^ 
imptdit. la tome Jinulic^ bovcvcf, th^rc ii link vuiadon. tnuae 
gnndchitdrcfl follow inainc grand pirmUat epilepsy m iht father mcuu 
ih« unc dfacMC in tlir child, and Mnxrenivt4bkcs«nofhcrrdiiai7 
4kid»olibni have ortme und«r 1h« aulhor's obscrvfttioa, In odc npvd^ 
§Mj it vpnwl impounbic tor any frnmiiy mifmlitT fo rwpr Th« cune. 

Apoplexy* -Tbc hcndiCuj tcodency to cr-rcbnU hcmcirrha^ b one 
of the mod BjikTnff fictt in medldne and it insfpmblc from iu 9Ui«r< 
uftiJTC conditbiu. aturio^dero^ dkranic Bitfibt'a diseuc^ uicuiism 
awl Uw dcgmcnuivfl diMUM «1 tJw htvi- l'h« tuthor hu rrpcrted 
A oue In wlikh. of nine (kmiTy membirn, firt iltivl ui mjx>pkxy. hvo of 
chronic Bfiii^i'* diseiae. and one of heart <ii*eftac, rvrry dcith otoining 
b«lw«n ihe iga r( |0 U»*i 55, The then siinn^mH broihet hn* ibce 

died of the dominut dbeoc 

Cmkv-— F*w pbyddan* ot ctperiraoo will be found who dray tiie 
Wredhuy naCucv of csoctr. jrrt it U w«ll lo uroid too rtdical itntrmenTs 
in Rfptfd lo it u tending to crcole undui? apprthcn-iion in the minds 
nf mffobm nf uintfit fandllot- IJkr npnplriy rhr imdmry In ihbt 
dibc9K b towudft dtiui in middle t^. the tranaimttton BCtmin^ X'j 
b« own fBOJtoJ frona mother to daughlfr lh«n Irmn fAibn to ion. 

ZHsbftOS. — Few (!i»c»M9 uv mort didtinOly bcrciliUiy Lboa diobclca. 
£1 vc TtjEftni tl OS one of the oJlenativts of iohrritance in ncnvius tnd 
nvntfll dbcRioL Armrdin^ to rrocnt ohwrrrn It U pi^mbtr m vj^nrAir- 
« iliatipctif bcnditftfy forro vhicb ii chiu^^tcrlzcd by no oquaiily in 
pZvdbpoiMMi u bftxrurn mAle ind frmjilr. or f^rrr 10 pml^^minium 
Id the temab- The bc»l cumpica of iahcHlrd dJaraac arc fimnd fa 
the fftce tbowing Ilic gn&tMl wlnefabiliEy. cjxmdy. the Hebn^,* 

Govt-— Thii di*dndlf lioeditaty dhaent Is polcnC In tljr prodiiritDn 
of ulcffo^ekranU, tpnplan'. Brghi't d b tM c putro inutitnaJ sJlments 
utd crrttrn fnirrm of dbihcfn^ lk wrll vt All foniu c4 gnuv 

HvcDOplullA.^Thif cilniorlinArT ducwc it atAri»tk In Its tnju* 
mlMHi, the deadly leadcncy lo ciccaive bleeding. aponUAOoiti cv 
IndQced. bdng tnnanittcd ihmugb il^t fcmslc* of a twoily to tlw 
Rttlo imat. In certain ftAilka it hu boen Incrd bsck for hiinditda 
of ^ran in uabrohen frquenccK 

•T^ ncndit&rr FoRBof DUbvM. U. Loet. ZestraJUtU FOr Inocfe 
UctUviB, Ai% It, 1905. Ho. 51, page fSi. 

CV^^O- VM- 

riivr ilitr- 


K«<4 Anil 






SfpUtiS. — Dirrci inquiry ii tEnpomble vid ttie pJiyudftn mwi 
ordiiurilv dcpmil upon ihr tcco^i^iui ol ouiwiid m'lpu <if InhcriiH 

TiitwrculniitiK, Thnt In rarr fnir^ncrA inln-rrub^if may b« fnn^ 
imtK^ irora mother lo cbitd in ulcrocanout be tlcublc*! AAd it is ccttun 
Oiit the iDcidftuv of Inberctiloaii in gnaifr in ilio»c of tt^oM km^ 
record, InlKTiUncc probably hii :o dij wilb nlmdunl 4n<l ivratt- 
ivIio'Doi conditions Thtds rctidct the child of tubcrculout ptRvl* 
or antccrdnii^ moic vulncniblc and Icta rcriituil lo llit- tuTimtc barilluA 
ih&n the on« uf lound. ri^nrouA nod untainted alock- IC^^tn prodispoMd 
children If favon^l tn tlirnaTr ;ini| tTivironmmL n«<l tcldcnn or nc%^ci* 
develop the ducasc. under otmdilion^ tUnunalinje the [loaAiljility <d 
oc^niact with the living gu^n, Uic ciceptior t>cin|j| Umnd in a UtMA 
[jrviiaUl ^looduki tnfcctiifn, rnfoiluiuttri^. htmcvLi, iIicbp 
of prtdi>po«ticn bom iniu I ubcrttilf ium lifiuwholda, art ia cvtrf 
rxpatpii. through (heir lUlunr. Ehrir (^mr^iin^ ihHr iPni^E^ncy to carty 
diTtv hand> and ii;fccicd a^tidn to ibc mouth, uid ctcn throujth llic 
embraces ot an in^vcli-d p«f»ent, brother or n*ipr. The peculiar tiajie 
of Ihc cfam aBH'tJaic^] with lubrixuluaia and fuunrl mosi fmjijraily 
in tboctt of lainLrtl alxk itt mrraly anv ol thv utructuml ptcuUfthbta 
anrl dlnhtlllia whith Imomi- fictcirt in jnfnnifin uid In ihr rnurv 
or tht diKue Tar marc Lmponani Are i}b«Tfucliona id ibc iua^' 
pharyngiP^ pauflflrt pupccully adrnfiid gT^>wfth* and hyppnn>phb<l 
tonilhi. ThcHC. [fl themselves frtvyrablt soil loi ihc tuberdc buillu*. 
by thdr intcrfervnce with frw rttfpiracioa prevent the dcvdopmenE <4 
thr hinf^ nnd acimlJy relnci (he ch»i while funhrr conirfbutrng in 
(nfcctiot^ ihruiiKh frc^^ueni rccurrinjc ^old^ mud chrome ntarrH. One 
haft only iii <rinHitIi Inturnnre n^LtnupK ii> iindrnUKnd hrnr irnEKinatkl 
are phyii'iUt and fumilr ^n'ml m fiirl<>rx h^ tir^Jcreutctffs, jinri il may 
fufthcr l>e Slid ihal ndmJtijfi^ ctrtum i.]Lti.-|AK>ni it it fientntJy liiw 
Ihit all i-vrqjiuicial phvaE(|ue lBt^l> iivcfbabnceft a ba<L family hiMflry. 

SptciRlCi>iiditioilsAflr«ctiAg Heredity. 'nM-tier^JAcunceof tuWr- 
i^ulotit in Ihr jKiniJls £t iippiirm^y Imi tliAiiily gr^Ati'r than ihal m 
bnjthera *jt MiAcn, but pmbably llii* it tiettiuw casea of jineated tuber- 
c^iJoii* ir^ tlie parvni^ arr Gchli^m in \ie rraovl in caie-taiiing. Euch post 
i-nnu ljeiii£ uMudly dthcr farjcoltm or conccAli-d. Any iine who 
him pnctiH^l in a rt!^<i>n fre#|i*fnt<d h} tuird fonMjmiJn'.'*^ will apprv- 
ciglc ihi* I'bih of t}ih sutcraent P1iy»ical R«4«nib1anc«.— Mrrp 
fadal rescitibbntt i* (»f liiilc impartninc. hvt ^I'Mtrjl iinrLiurJ likeneM 
te dUlincdy to. Bipottire lo Infeaion.-l hr hc*!th of living family 

uiAiyta 01 ctsTAW cmotxni cvdi-Tov^ 



EBcBibcn And c«pcdftlly at the children uf parents iindti cxamitiA(Io&, 
M wit a« tbr mn<Jilton of parpnis ftdcHeri hp or dying cf lubcrcu- 
kau of Ibr timt ef JAc 6i>j:4 of tny lodiriduai under cjAmiiiaLkm. ut 

PREVTODS ILUfBSS.— A knotrlalgi! «r Uiegtvtral iLatr (>r hralih 
lad (ii«t illnoMa of a luticnc may «uIa the diagncau. cithci b)- ihc tx- 
Cbttioo of &<liMUrnr ih« pcnnftncntdr lempomry CmmunllV'Cniifrrdn)! 
tjpc DC by filLinK ft ayinpti>m gn^up lu the kiiuwn ttxrr tStxtA of ft 
pnrioiu illnea- The «xanthrMiatt> ind fellow fever itluttnEl* Xhft on«, 


■GuumBcl Ailments. A palicnt reporting 'Stomach trouble" 
mxj pfinmi a rlrAr hfi^inr)' ol }>nAirLr iitrrr. KppenflErHJfl or jirnll Kionr«; 
AnotlKT mttf ha>c tiAil retrcAifil ntUcka of ncute rhcumaCiiini or kouI 
«nd ouralipntJon U ibuit direcivd io the hrtLrt. blocicl vnMU. hidneyt. 
A hu«nry of vcirrc luxtunul headache may be opLuncd IiT ^^ indtnl 
ByphOtt, or bji tntnctabJe pcTiodic neuraJ^A by pod malnru. Jn nich 
fwftTTiifiitff lAr timfitii Jitii tfKtt kit^ndy pktt^tUogy thould tf. usrrf, 
capedafly in dealing vilb the icntmnl itnd learlinc ()uc0tioa» caiuiol 
wholy fce Bvoidwl • 

msioRY OF -^pREsEirr AiLHEKt^- aud analysis op 


L Hittory of Pre^«nl Aitmeat-^Thr ]al«rl thiiuld tell of hit own 

^^■jlltiMt bul in u ie-K wurda as pouible the ^-mptonu of hu diic4ae 
HHb ihdr duration. Any ictempi to theorise or draff in immatcruil 
r bcba)>i)uUbr UuiiuUy dirtLojI. Tcjicuideanddif«l ibc ^iv.hi^uTrs. ! |-i„^|^^,. 
I <hrA verbosity uid triviality ^Ad yet u» f^w loidjngqutT^tirma a an '[^'^J'l^H' 
art bolb ("aluabir hnd rare. Ortt ihmitt 4i%<Tiniiniitf brtv^eirn tkoff inc uur^ 
lymp^oms tkiti atr (rr/^/d/ rn JfmV natttrf. f^mnton to j krgf numhff 
of Jiiftuti and ittbj^ la variaui inirw prticHe^t jrom Ihow ihal at* 
Utioi. prtaiitir or tpvcifi^. Some of ibc pilndpal fcmrdi tyta^mnt 
will b« dncribvl in Ihli eonnrell'in and only thru tpcdaJ fnturM i 
rr fe rrpJ to id nthet Btciiaita or andcr Ihe lympLomaloJcig) of bptcilic 
FEVER.— FevfTUta dinlcti niafiif«aiion jk inertly an devittfon of ,Th«rai«n^ 

iIk bo^y tcvpcrslnrc a> lofmerty determined rouj^ly by ibc band' 

■An iniicffiAL paikni (if ihr «uthcir ^;\titt *'^ previout}) unrreiiciiinil > 
;>eifomfam dnodriuj ukrrr:vtay vdnucicd haviitc faamrr1/"puLed"Tilafid. 
I^cnttlb un ivfiulvJ iiiialijjctait be had dcoled ''wEltilng" nt mtty kuud. 







but nowadays icruraiely by thr dlnkjtl ih«nn<imeC«r In SRcfc di 
c«9ca as pnriicnuTiia and (nihoid th« akin ia dry And liot. On tlic otltcr 
hand a hi^h ractaJ lcmpemut« may ejlai ii) cbitJirra and th« aurfat« 
tcmiKniurr br u lov ta 70 ilrgi«cs^ The tlicnnometrr b ordkuil) 
ftp(4ied Xa one of fouj pmnia. rhfjc bang in A* oHct of frrqucctcyp 
Thi* mouth, thr ifif^u. ihr rft-iijn ani thr tvigiaa. Tbctc U lui poiifTT 
tnvfstmcnl ih&a a cfitap cllnioil [hcrpaooKtcT aod the teat scaka 
tuppJicd nith some of thow 6l th« lover gndrt ttt* worttdeM 
by maon of Improper adibntion. imperfect aeMonin^ aad mb rt p re* 
■entalLon on lh« put of the manufacturer- In ihe ute ol a tbennoni- 
Ptrr. r^rtJiln pirf^mU-tnn muKi hr iilwcnrrdt — 

(a), Ilal^Mbt<U»t^^f<frt<mi^lifrun. Q>). ThtH^ihcM 
tm^arviUy br tmfefM aa iht th^momfirn htt wlf wfSMttin^ and 
require 10 be ahftken down after ax. (c)- It used in ihc mouth, ii 

ttpn (niA Tcfih) vi Ihf puSicnt; \U for an^ rrJE»<jn the Uin cannoi be 
cloM^l if the fHLtif-nt he linoon^iouK nr di-'lirinun ar if an aoutv Aoma- 
titia or tonulb'iia bt pmrnt tlie t^mpeniltjre ihoulrj be talen pn rer- 
lum, or in ihc viilla, (d). j^^rr ttmp<Tatrra shoM U avaukd 
whmvrr p<tjrihU. u bdnff mbjcrt to greater eimr variniion than in 
lAhi^r tx-):Jtiii»i. If «f UikcjL 1I11: thenAonidcr alirnild tie pUiol i\rc\Ay in 
the axilla which ih^<\ h^\e brcn frc«d from any moJatun pn^^mi ^rul 
Ihe elbow of Ihai side ihuuld be dodr? In tbe IkhIj and carried mvi\ 
forward. AicUhry ftadin^ art p^iHtttdath misffwUti/; in iteifitml «r 
bui Hij[%liy ffbriTe fitbcrmt^jit 

Tcmpcrnlure Range in the Ilunian Body.— Our phyaioloeEalaaiaec 
that in nc^rmul p*rvin> die nnpc mxy rvpnwnl ^.^ 1^. aa 41 omi- 
mum. and 97.7'' K a mimnjum. Sub-JebrUt IcmficrBEurci ur tbcov 
running from ^g.j; to loi.^i; m*fdfrsitt Ifvtr, loi.j^-ioj* F.; *if* /«r(r. 
toj'-fo^'P.; hvprrpyrrrii 105'+ There it ■ ntinrml daily variation 
reflected in neail/ all tctrnk the mif^ brJnic alxiut r^ cff 1-1" F.. llic 
lowrat R^ilinK occurring Er ilie mriy hoiirt lollf^wing midnl^i. Ibr 
highest lirlMCfxi a and G o'dcjch iii Ibc afEcmooii. Grazitiujj iLal 
99* K. to 9^-5 or evon 99.8 may reprMrrvl a normal variation in tnfanta 
ihi" author Iwlinea thiU the range w ordinnTily ^^cn hi- rhc ph>»iciki' 
(Cbttfof thcadulliitCiohiitbandlkBJcdiipon obanvaAiona whkh indudeil 
perw>n« havm^t if^^^iplf^l dicrur, nirh a£ piilmonary tiibeiniloaia. 
V<aa of obtcTvation m privalc And |Jublic i»ra<tzte liarc (ontinLnJ 

Mon.— To MDven F'ahrcokfa*!! nadinKi htto cvnii^bdc miildply the 
onHgrtdtf retding by ^.diTSdaby j and add j». (S«* tabki p. 643.} 

ufU-YSU or cniiAct comoic ^Yvrrooa— -rrvn. 


euUfiP*,tk*p*sHa/vjmtafmu^ffm4mtfir^M aU^^ffth it rfjeratte to iomt 
/ wiMtftfeiJ cdqJiihfH^t By far ibc i^rolcr ouiabrr pruve tu be cue* 
ol ifififunf tutirrculQCia. ft COfidiCion nco^bod but rwEy until witbin 
the East twu dmaJeA. 

1% ihould «l*fvt9 b< rtmcmbcrcl that tiolcnt cscrcbc ui^ cxcosiTf 
htM dlj[bdy Mid rempunrllir rnlo? bwty rtmprmmr* ud thv In 
itifutt uid rcry old pcraun* \l may nnt^c liaJf a tJcEiee or oitirc HikIicj 
thjm ia ihoar ol tnumwIJai* tfit. TiM tttnpnaiur* cf ^hililrto morv' 
over b oufljr aTftted and maif wach a Iu0i ilegirc niilioul serious 
^ ngni&co&cc^ odten subndmf? ai nddcnlf a» it come. For vftrublv 
^Hdoib to oTUla cajca or tubemiloaU mdic or cttnmEr, jJk fwirafiiut 
^^Hfci'^fB'c reprcaent* thr majdmino- 

htboloflc Vftrtiitlons !« Tftmptrntiir*-— Hyj*rp^Ttxia of eilr»- 
onfinarj tkgm has brcn rt ported, Liut haa prvbably been due Ui dtccption 
OQ the part of ihe patient, it being a common tridt c( Ih* nulir^^crer 
Of hT«MkBt padmi Tn hr*i ihr ihrnnnniptfr Si»lb hy Mrtlnn. bj ukfng 
h«l ddeks Jiul bcf<^rc \ht \vht u nppbr<i or by ulilirini; a hc-t watci bap;, 
The hlghoft tmpmhtn obwrvrfl by the author was 110 uoder tb« 
loagc«. uid ocdUTcd b a ^roman of byBtericAl (cmpounrnt uSmng 
inm ipicial cane*. EJevntJoti of tcmpcnitiirc may occur in tytferio. 
^Hbct never lobe forpiacn. Tbe bi|i;titst perKHutlh oWi^rd 0o4*F,) 
^^^B o^UCaed daring a« kjVlttinU pftroarysm folbwing gnat cireoiional 
^ocfe an4 Ae ftiu^k a-td th? frvn lubtided jJmofr hflArily under! 
aharp owUq prreasun, Sf^me ftuthoritia daim thai tcmpcnture; 
may pcnut for week* b hysMria ^nd even KimulAtc typhoid.! The ' 
fllgolicuKc ol high iVftiUBffi *^ w^rdAM and ocrtAlD bjpcrpynaiAaxtni 
10 fiidk«M Hull mort thaa aa intent Enfectkin aasoetabtd irieh viprou* 
ooftHflodoea] raiAlOg pnver. such oun befng «ren ir coriTiniion 
vilb lobar pcKumooii* m which a lempcnlurc of 105^ F, is ndthcr 
mcoa u nop dct ntoetttrily of IauI tmpert. Etiremcty hlflh readinf^, 
H imt JP tf j f uaJ, intUo^e « ino« serious pmjptosia and ■ sudden rbe 
•oRsMbaea pA9c«dc« drith. Sbtnormal fRop* ntxirte may b« obierv*d 
in tbuac wlIeriDg from cc4la|sc. e^nmic exhtiiisJng or wuiUng disi' 



* Ma*f jMCB of dupnk larval nppnuUdtu jndd kimlUr iriLpencurr^ 
t A ncvol iBvndcatlos ol numo' Icinpcntur**, unJcrlAkcii W llir lulhur 

10 a local ba«mial hiia furtbcr ttnuihcoed this optnkin, 

; I'acU wc Ldov Mkorv ci lb* raLTvutim «l byittria duJu and fiad f^wtr 

^■anifiia of 19 Cowfurioa wfth oripnic aifaratt it niftii b* tafcr 10 ufuna 

that wv ^'i***** ^ frvrr t^u^t bpienjt 







jfSDicAL niAOfoau. 




<Ufteu«.* vtc- OfEen^niM (he jurfatf trmpfnUmn it nAnomW amd fhr 

rrritd hif*h nnSiibt^ in thttim^ iinA iHJfrtmlAHt. 

Febrile Type*.— Fonunalcly i(^t the dinidaot the fcitr m siaojr 
of iht ftcute diH!«Bet pursua p morv or U^ duLracleridif M>un« ot 
tx«n « pcLuIiAf rrUtii^iJ Eu L)ic aij^'carsncc uf otter >>ux|'1ijca» of lie 
; dUi:««e. Vcyen miiy hv (Jftctd uncWr three i^ticrtJ litods: - 
I I, iDlermUtenl. 3. Remllleat. 3. ConliaDOitf. 

I Ao iHicrntiriiiii jn-cr however far u may rise, 
, <lrcipft [o or briow nnrmftl during wmc pan at 

the 14 houn (we fig. 5). A /rniitfr^f Jrvrr 
IflhovTfl in»i^«d rrmiui(>nA durinp; dw 9:4 tuiui^; 

whik' iu ci'nfFRium) (i-vct ihe raiuwuoa vf 

atr^l. ThkMc an: bul the lyprt and ^C must 

uiirfpp*(flnd Ibnt A coniiniiou* frvfr may at 

53nac tugc vlaoip lemJmonA. or a retnittcnt (evrr 

cnctoft^h upoTi thr [nicrmhtcni: ]i;<lr«rl ihv lerD' 

pcraiUTv chofta rovrniig loug pi^nuihi mo>' in 

such dia«aw a* tuberrulcmi show evcrr tj-pc of 

frvpi »ncl jci be prrdomiriHinily ir\tftmtitcnt 

The intcrmilKinE fever of thi« clique i« r>Flcn 

glvrik th<r niirie A^-Tir Rmifthly ipraLir^^- -mii 

nux ftny thai «licn Ibc^ niajuinun] rlaily >4rijLinii 

in a mofleralv uf fr^-crv Ir^vr 11 Ich thcui j 

cfcgrrw K i* mntinuoui, wlirn mnrr than 2 dt 

fpxcs and j«t wiLh on a^cra^ fnjnJmuia dU- 

itnrrlv nbovc the nnmuil h t* rrmftimt; *nd ^ ^ 

Dial Any lever MKvwjnc a tcndrncyiopcnodicAlly u! Oi-tuMo « T«rii^ 
'fill CO or btlow nonnil. u inlrmnitlent. The t,!nk\^t'n^itnt tamt- 

fevrn of the contlnueil or rrmUtrni lypr juirl t<i S\iMt»"i 

the dianac u wet) aa lo the fever iticJr lia opi>o«Klc b ciJIcd dw 

pf riod of d^f/nv^r^Uff -n- 4ftiinf 

Diagnostic Import of Ferer.— pLiidng aside the rm caB» of bya^ 
Uficftl temperature juid e^cludinft decepllDn tod i»ulty lecfaiiqilc. opc 
Q3«5 ny Ibal fcvct U pr|fn«rfly of inlLh? Iu prtMmi ikr rntkmt^ oj wam/t 
offani^. admrnt a matlvr of do tilila fanpOManoe in dcaUnic wJlJi ntutrU' 

* A inngvniiiir? undrr 40,5 K au iwoHHiy obsMVtd hy thir iiiilhor In ao 
•armMiMrjr mJtrvJ <-av. 


thvnks lad nulfa^nia. Fistfaermorv. tavc in <hil(lnni. il in^icilei 
ififectioD «r BUtO'tfrtiMbciAkc ncuk or chronic ot irnuiiun '>f m^idc 
ponlon od the cninml Mfvouji ^lem Thr ahftcnrv nf fevrr hi>wn'cr 
divck sol rule mM An? one of thcw cwditHma, f<Jt their a no dlnaUK 
oTdillufljr MriU IhM tn»y ivrt thoo^ in 1\\tf nrvti inAlaJ^cri «xie.t 
wilbowl ff VCT or mil hliIl aub'iiurmal Umpttiiuic. Ii h lM^^I cMmpli- 
ftcd ia thc<MCo£ airlvilc trphmd. <KC«Aona] pncumoniius upccUlly 
thotf at dd igE> snii crrmb ctmtcf Kmrml ivriinnltin. Frvcr urmfi la 
eoftlEt- lilt rc<i|>nK»J wilan of Uix«nil», jfifcdkin ind indivl4iu1 rcsMlinc 
pa«<«r. By far Uir ^taur nEimhvr r>f rcvtft »« fhi« in the actkm of 
psllwccnu: gtTtni vid iheii luxino. )vt niau:i> nre due Lu vilter toiic 
mbilwitti Of crcn lho«c gmprafnl by the body atsdr a^ in the 



M 1»«tvciiL vi-ux^y II wfi'i ■■■ iUuvitacf III? (uinJiiiioiii unJ friv<itrni ivirc 
4ii<r 4t«**«*>l vlwivt Ihr «>ftI]M"«l*itl«^*r ' irttr or fhr rif>l vrrli. i V^ilci^nl, 

ptimAine |igpiriniiig dutr lo Ihc tn^crMHrn of thrlclvriuus fucjil pnxlucU 
Aiiid Ihc csriout aatoinloxicatJQn «Mod)ilc<l wiifa defidcol or Inulty 
R>ttihr4iKni >a SIuAntDd liy the iimrinal Magnof dlAensn ^f nutn'- 
lion, of oulrfenftnt dlK«x. k^mL und ccrUm ot tbc x\xrcT typcA af 
iimiiwi Fever of crmlrsl Afifftn mny he enrounEfrrd in eerebnil 
emMiira. ihroinbuM*. aiiuijlcxy. htuln limkiir, aeiiJ dim.t injury, vi cvrii 
by (be c):Anj!V9 mcidiiil to hcal-rihumiUm an<i 4unbtr[ik<*. MalnulrJIIor 
i« tnmi^iimH it«»dated "ffitli frvcr. uvj^illy uf a mM gnuie, which 

onfinsrib'^^i^^'t^*'^'^'*^^^*^^^^'^^'^'^^'^ OMockled trHh much 
wMvg of tifwe i»l k«« M «ren;pb_* 
OcnittiftE anckr such condiliont 11 b nwfe fJJbly In be iJuc tu a 

*T1v »x»BBd "hwyi" lenprratu^ nuy br m«l mitlvading in cm- 
nkHtM typhoids tt^t»*« hfttt too long >^«rvEii. 








17; mil hoi 



ttnoaldeniig tubcrtdotu or « <omplkatioo, thouf^ il cvioot b« domed 

THE PBENOMENA OF FHVHIL-Oqc muat fint dctonune 
vbeibo- Ihe lever <mn» on flwld»oJ)r or gn'lualljr. wherh^r it mus asaO' 
dftlcd vriUi cblll or ia Hnt child cdovubbmsp for how long il b^i cadi 
^eibcr it ifl Id be diusitinl u djjiUnctly intcrmillenf, rctnittvat ori 
linuuus. ftrtil junhcrnwrc wbethcj it b jumkiaICiI vrilh an; liisliiry of 
f«ction or with the tppcaraiKC of ui eoathciD. If \ht IaIUt b« tho <aM 
fts enfl time of ip;>fann<T ard 

CoodiUon ol Ibe Skin.— In 
mcKt (even th« tltin b djy And 
pftlpahljr hut. Otxaaiotial curs 
deport from this rule juid ccrtam 

tiam And cHotcni Almo:il mvAii- 
ably tIoIau it. 

Digettive Ori^uu. — Naii!ifu, 
voraitinji or dkrrhcca (inititU. per 
HlArni nr iprmirudv ronsiipa- 
Ucn, loM of tppelilc and « 
OMt«d tOEi^u* 1^ pirwnl in 
varyiog degrees in all •Errere 
acute febrile tilmenbL 

Thfl Vervouii 3yit«m<— 
HcwUchc vid pAin m the Umba 
ire preHni in atxtij all t-iah 
of fever, thou^ often only at ic£ 
MMeL Th« mlit'l may b« d«ar 

In PclAtion to axij ri*e or (all in |!^jj i j ^_L^LlI* 1 "^ I " h T^molq 
the tempcmiure must be notM. -ow- ;, ; !p;Ei;|i :|:J;'J;;pam! 

ilFT«>v**Hn0* hf If flt« hcfltnUit* Mil** 



or douiled vid ddinuAi nuijr be present aI the oucl only, or for 
hiaj^ period!. oo&tiaiiDUsty or ooly At night. Thit may uJc« the fom 
oi CTsnalrory ftludorui or hwlkirinatfao^ may he v[o1i*ni And Riajii. 
acaIi cnildr » «J the low uniUcrinj^ muRibUnie type of the typhoid 
iUte. periiipA with open but imviHn^ tyn (coma xi^. VtrtiKts^i 
delirium of ibe violent or km niutkring tn>c is of ludnuiibk 
lignificaaee. diOdreti show an efpedal lendency to ddiHum evvo 
in fever of modeiaUr mienuQ^p wbacM, Ic in rtfc in aduhi nvr ui 
Ik swot mytT9 type* of ufection. In Ac InUwcaUona or In oenlTa] 

llUttSlV OV CXItTAlM craUIOfff SYUrrOhCi— ITVTR. 




Acute Febrile I>ctiiiun]--^(BcU'» mania)- ThS»nfecundjliCi4kprca> 
hAr lo wocQCO Ukd ol unicoova CAUutioo. i& initiaM by^ock orctber 
cmmional ttnin, wmI may be a^stKinieil with tbe conraln^^mi sui^, 
/I onwib ciMftiMy of a cwimf. cmJMMiHU, crbani^fHf i^ mtiniaial 
<Min'iMi. difiuidlAtf vvjA ki/^k /avt oh^ o typhoid t^U. N^ spedfic 

cDcfrxindctl uiih the acute mitomal 
ddfrittm occukiDaUr prcjcat at Uw 
fm$ei of pQe!uniDn.l£u f^hoUl and ur«- 

3; -!"J"fJT^ t nwe- II U rapidly bui, runiuiij; Hfl 
i-oun44} m Irum one t>il]n>? weeks. The 
diilt^JtuiiAl tliugriLiMia Is one of t^tduidotL 
Tb« PttlM 904 R«»pir«tion, Both 
jiiilst antl rr^iraiTon brar a ftcfinjte 
rtlalJon to iht lempuAturc iur\x. Tbc 
irvcmut In pulB^ mic is <iR]linarily frani 
S"to IxaU fur cuJi drgnsc of ft^ver and ' 
m defiaiture from Uus rule is capedftU)' 
noted {n lypbofd fcier, yWL^w ff'Vfr anri ivpiimri 
tibnr (incunioriU. and rAv<Mnbly ofTccU DiHifi!'"' 
Iir>gTi>^» in These dteun, The heart 
jquaUc tufTcr^ to a nmbte dcgm In ol] IImtt 
infecticina anil iDtoaicatiqnc und muatt be 
i^arefulfy wolibcd furwgru cnf wdtkurvi. 
le^jEiencralion ar valvular In^LmiETiatioii, 
::: UHTig rtfirrUIlT tnir aa tfgaink tbc 
ij-'Li. htart mutodc and p*iic*fdiuin id 
atlad^a of acule oi atibacuic rhcuma- 
li«n and la diijhthciia. Tlic pubc of 
ttijch fever oi the sa-ciUed athonic type 
is ncil unly rapid but full and bcwHiJi'ng. 
In. ulhcnic fcren il becomes Tcfu tcoJl 
tod in Ifae l^phoM ttaie. diootic Jn 
&CUIC and cbronic Alfc<tion» of tlie 
h»diiex k b of U^ IcndoA and wch a pulK ihould alwayt ctirect 
aucfirkm to ibe kidotyt. a»d call« for cwninatlon of ihe urinr. Is 
'""■TT^r'r" of Uic pcribiocmk it b snalt, hftrd. and wify in feel. 

BZJUUuni*.— Tba aocompanylng chvu then the prruliArtlm of 
Jeter in ccrtam dtM»9C& Ir m$da the tempcnlurc reoedcs a^ li^^n 


bw HfTft Tthrni tkwiii« tar 






at Uicrcttbouts tfter the oiucl. lisinK lo icvd) ib tui^>f3i poi'nl vHih tbc 
ooj&iitg of tiic nth on the fourth or &f(h ^ay. 

GerntftD M<«lde«,— (Rnihdn). la rnihdn Ihrnui^fion ApiKHnoit 
the fint dif or more rarely 1 Lie ^ccottd. and U tisusUy the first ihtn^ 
not««1. Tlir frvfr rffin^mnrhihr-ttimrhiif iiniuMyli-n thin in meuley. 

Scjidet F«ver- - In Karlci f«v<r ikc mpidlr apiVftduig TA*h Jipfwart 
on thv tirti or brgmning of ihc srcon^ d^y foUowinjc nn ^tupl otiki 
with high ie\cr. 

V«ric»llft. \ChJ«kcn|>3x). In wictJU ih« ruh «pp«fs within 14 
or 36 houra MW>ci»tRL wiih It^niiiff fever 

Variola - (Smallpryvl lit v^riiJa 
the violtnt (inwL uiuilly u'JiH rbfll nnt! 
hj|[h focr u followed by 4 mAikctl 
remuHion dunnn which the nub ap- 
|>ni8 in iu [ttjitlUry sinicr^. Durlnic 

turp riidn^ mchn iU maiimrim wh!i 
the purulent tmufornutinn of the 
v«ctclr« jukJ then i^niduilly mb- 
flMlra^ Thr iHaKiiottie vaJuc uf ihrac 
di0rrcncr< in t)i« irbtJun or body ivm 
pcnlure to thr cruplioTi rt imiiily 
Tbe Mode of Oni«t and Termi* 

IUltkM|>~^Ttic iiHirc x^crrcJ the MUtc 

lOfvcliMU tkPt u*iu]ty ptvcvded by a 

deddcd ''chilLuiTH" nr a^i aduai chJll 

fe •dulta'* and in chihlrcn t^y «Kher 

chlQIng or co&vubioiu. In vrvrr^ 

ditruo bowercr the cavh b inaMicu* 

and wlihoui TTurkHl initiji] ptmonkcru v>d in vrsdr CUH Itila Bwy b« 

true cJ libiKDli utdinnrity Innk. The tcnsBiuikn of knj b in rih>i 

C4sc« ■ s^doal rKvttloa (l>«b) bvl <MtuD •UnnH* ol whkh lob«r 

(«irsmiicii« U ihr Irpr lemicile Mtdikcily (crin) The £riHad ph^' 

ncfnnu vnrr SDOMwhat but un^llr tbe tesipcrtlsrc biU lo ot bclonr 

lUtfTA*) viihm 7-1 bnun^ ofim jri nvw alinzpitr. wflfriDg b 

rrplntvd by teUtfvc cnafon, imtoc *wc«tinf «d41 Kuneiimn* 

dnrrlMM «cnir aad the cnnmit b «iBM csoit drmtic. Aijia 

*A levtTT chm fa orminhr Wn nueuUy atncrrrid erem ki pnEdmowa 

Pf*4i. iriw WllCH'a ~re<d 


itw (all in tcmppiaturr in dJwmi noi knorHi^l wLih true crltls. 
pnioa iBunll> to & M^ua compUcatkia. ixi typliuid, hi txhm[Ai\ to a 
bcBoorriiaip or rierf«mu>ii. Ic oih«r qi*m ii may bp ihe aottmoincm , 
pviulO'Ciltia. In pn'^umnnU. x |i*n»divrrisf«(J mnrked ifcgfoe is ofirn I'wurto- 
folloirrd bv renewal of forr. (he true crim (x^urrini; <irdini4rily on Iht n».rii>nfc 
iiay Mlovtng In onr case of ntignifiry jiru'iimiinlfl nhspnTii hy the 
uilltor. Iub« Bfltff bbc of tbc lunfi «ent thruu^ih a tjviial imcuniouk i 
<7ck; Ike critiCBl Ul bctaR praoiplly folb«cd by chill, rmewcd lv\«r| 
&Dil the uiual ilgns of crKifr>]frUilon in the niljjuieni lobe.* I 


an F»1 <TtTlT»TinriTr:Tu7ii!w 

■ - 

- *- t ' 

:i: ' 1 ! 

L r- , . ; . . 


■ 1 


-j ^Mi j: ^ 

wid 111 n«tf toon rti« ifivjk]ciK« ol ihc fiMitwl iHjtiM- 
liltTv.iFr<HiTi Wilro*'» "Ftier .Vnnlnv,") 

EA Ain> ITS C01fGE!(ERS.— Comn cover* any suic of pio- 
UBvutsvdouMirv ftt'iii wliii ]i d lAlicni c^n be actruKxl utilv jinrii' 
r. t««i|x}nih})-. with tlilliojliy (T not al all 1 1 h« d^iUtnglinrMwrvn 
Teittil 3iUlo of unccnviuutiicv aikJ pnjfound clccv '^ ^^ dcOucJ 
Uid one merRCS into Ihc other. The trnn fjimd U^/ in applied lo the I c«rni viili 
p«nliv mmplcir fv tpmfun^miuli^iMnm uf crrtain n%a at lypboM 
ft>«r wsotiatcU nilh an ipcn eyed, I'm muUciinjt delirium. 

tin »tf4 iA>t«ncr« rruc nam* U asaociUed whh a rchucd Uh, M«- 
lonjin Weaibhlg aad itay um^c, e. j( morphine pc>lHning «i aigo^vi , 


VTDtCAt DU0!«OfirS. 






BiBpo'&cd L«lhJU|£y'— U<>Lhrcpnacttl«lc<porjleic|iiiicw.tbcfoftner 
profound u ia licoholism., thr ialirr ■ mm drominMi u in tbt p»- 
tnonitory vU^rc ci irccAing. Asdumiiig thai a paiicnt b aan fof the fint 
time en the AtrccL in the ambulance, hofipilnl or the bomc. tad U comM 
nv nr iiLiji^muft. th« diflirtiltin in dUif^cHU vr tt> fiiroi ak cAfO to 
bi^c Ihc dla^UBitidjin, Yet mhny ftvoicJAbl? cfTor* octur thr^aj>h U<h 
of prapFT mETihod arc! {>r<tirar^' ItnowEvd^ Aod riirfnlnwn T^U 
MnJidmi untifw whitA an tiliat^ occurs »hodd be finl »u^ tinougb 
wmc friend, reUlion or bytUutder. Tkf appf^r4m<4 ol Ibe pftbe&l 
at llic ciiiti; ijf ihr »iuck. hii moie- 
ments and the dindion and force of 
fait fall uv also lob«cniisiiJr.-r^|, i^ift^n- 
limci his hobils <n even lis prcvJoLxs 
health may be uctiuined. Tkf >titr 
of jA« atmospturt may at cmn- auigcm 
hMl-ohftUStion or »unbtr7k<r. Inquiry 
miut br m^^dr m (o \tftuil tht palifttt 
has takrn inf^ tht sttmack. havii^K J^ 
ntind tha pndbElliy ol |>tOiinaiRe rM 
drag fKiiiMuiuK- ^ uf ujJdc^ii tkatti^ 
ar lovrr pr<i9lra(Jon fotJowin^ lji? 
overlfjnHing of iht «omarh in vicrms 
of tlic dbc4seA ai the bcdxt and ortci' 
Im. Ia publk cefvlcnt the hJMary Es 
often cntitrrlv lackini or untruttaoithy ^ ^ 

And lh« pnysiaan ti thmwn upoo hv uiiu I'ntkH"*-* tsowiv <riu 

tpthpif. malmgtrimf. siryeMmia. ktt- "**' ' 

nfd. afiopirry. itia^lk oma, poiumimg hy »fiwm, dU^vf cr pCA« 
Morr^fku, If deljrikjm Is prcicni. Mta</fHi«tf, il conTuUons. Ofytknic^ 
anil InvrsKgaieftt — 

(at. The Byciii— Ajc tJic pupob equal or unequal, cuntnkinl or 
dilatH f U \ht corjonctiiral ntf ei pttJciU, do Act ^c^ct td II^U uid 
is then* rtsslatiu: lo the w|ioniinn of ihv Mdt? i;«Hf«»Uy dtfoU 
^^ (the Urj^r usually qq the »dc of Uw IcbSoii] ft^jp^ CcrtbnJ 
hrrnoFrbaj^e or genemJ pnnlpti ex\ thr Snttae: (TMfMdhrf PttfiU 
wggot opkmi pobomng, or ponl^ betnonlHip; Ib trvnia Ikry art 
tam^y dikki and to ^11 ll]<«» cooditinns Cbey fiil (o rotpond lo Ufcbt 
aad lack ibc DoajunctiTtti fcdci. Thcaunr It tnir <if cotaiopandthc 
latcrtttptof cUorUpoboninfE. ^j ommJiimim arc /reimif wiih &i«4. 



pupda and ab4c»i c 'njunctival K^fx epflcfnr or poiKoning 
bf suydmia, or kidk other toovuluot is aI once ouia^cstcd. In 
«M«'(in tht popib nuj be <Lilated. but \uiuU^ mpoti'l to Light. 
tijaMA iMd ma/wfrriif err oj a ni£e rtadHy dttnCtd by tkt prtmtpi 
rt»pm9e U li£ki, and ike retistaiKe aimott tnvarUbty ojierci ia Iht sip4 
pdtffiN «f tktt Hdt by Ou pkyrkiim, Kxi ntnmlnAi^nn of ihf hArlr^imd 
may icvcil aa a rt i n iiiimrM rOiniUt ia urKuiin ur c^lrri^ dul ia bnkk 

(b). Color. — In akobolbm llic fkce is UMuUy fliuhcd, id cctcbnl j 
JwoD* it tOAj be fboshed but U UAmtly cytxaolic. id untmk there uc I 
onrltn«r9f fmHat nnd cytftAk nod ihlK Inrirr nuy hr cEcnedv^rl}^ mnrhrd 
is KdAjailiilc poiftCMirni;.* 

(c). Ttiv Dignc cS Unconsclousnttt* Th^ corjuncts^al rHiM 
sbould be Uoted id all caoes. Sbajp prruurc over the orarian rcf^ 
auj naoln dndit in bysleric EfnuJ«, being often noctmipuiicd by a 
coapltic tf panUl rctiiro 1(i cum^JouxuaA. Tlie mfLlinKcrcr and , 
even Cba alcoholic individiuil tnn laeldom raiii movinj^, if sacb a itlm- 
nlutf aa the ihaip piacbiog of tfae tkla of the terrr furfare 6f ih» arm La 
mppUed, Off Ibe polka mcdiod of pounding tbesoica of tkc feel followed 
la t^ otlttf and more wftoiu fonni of ooma. uuciXEibilit} u aa a 
nJe coanpltle. 

(d), Tbt Ifature of Cofl»uJslv« Movement li Pr««ant -In c4T« 
bnJ hemorriui^ ra&jugulc Eli.'tja( <jf iliv cyts and bead is imittt corn' 
fiioa, fa the oomatoac teiminaJitageof jtrrdinUpcuoaingbothbeaii 
and trunk ace fovolrfd. opixthoionot orrmpmsihoionaB are Likely to b« 
pmotf and betrccn ibc AiUiiu l}je pAticnl mAy be cuQ^dfAii and 
ratboalt ^^ Utanut Ihe cDnvuliii^e vuurcfl are LiktJy tci he limited ; 
to Ifae Dcck aikl jaw. au<l uniLplctc reLiAaliuu bdwi-rtj Kifurct duca' 
no! uvaaUy occur. In 'f^^y tto mjuenoc of the Jtifiuna, Lc, clonic 
Bolloved by tonic oonrubioiu and the abvnre of opiflbotonoa arv 
WPprM^hr 'nicn:ialiaifacxbfooiy)toailunpl>:onviilAQnaon account 
of ibe diflhoilTy of Imiiailort. In tivsitria^ ihonnh often ntHkingty 
qiikptifcern or tetanic tbey arc uauaily irrr^lai ^nd uwHuilcd tthL 
Ibe typical byalcric f idM, and tkoagh Iha lipatnay be bitlcn^tlie tongue 
la BoU wbcreaa In true e^dkisy baling of the tongue and intrai linen ce 






Statu I 


1 1 1 %unt 

*Ta a fMftllag CAM iccu br D^ QaldorSnrve profound conu andenrnne 
CTBiicau wen DipWaed by ttie fMl itutl ihc patlcbl hud uvi] n^i muth m 

uDCef two povaibef afirrparatbn of bramo-»rltacrr=4o-Rof7i, of Acciiuiitld 
daOr Icrr icftvBl Epoaika. 11)^ 
tN«f4b«T ■ 


i ^3t Iot icfteBi epodiIa ' The rue rvcovcrtd. 

I tN«flb(T m Biryehou poanaing nor Iftanii* dnta corapletr, petvUtrnt 

I TflffmrH^ mnfti ttiptrvene anQl the trnnmal viag- ftnd ofim ao( at «IL- 


mepical &JA«M»ra. 







of Brine daring Lbe adioTM m hnpofunt ligru In h^ni^ ipivitts 
the tytt ttt< luuallr doMd during a frtcurc ind cmotlwiAl uticrtncoi 

hilanilkir luid liyjjcmjulnicsB uf Ihc »^u] amaia ubvrmbic ii) 
■tfjcJiniu |ni«ocimg nrv tibaenl in bjrauria and the oa«t oC gpoMn it 
(c). Pftnlyai*. The lUahi, tlovXd d^^bv^ Ise tuadlcd to uctrUJn 

If ptnUfift tir |inD»m in any mcmlior. the ji^riiltjir U^k of Jtll musck 
tunr bttfijc usually rrtdity Jcli'jttiincil anii i^iniliHd vf ihc musdci 
of iLv «]rc and lam ouuly notc^'l. II ponlyiui ol ibtf eitrvniilic* b* 
juHQi;bUd vJik niArkM AUofJiy tl vtU of tixinc Miggnl on nM lokm 
vfKieli miv <4 may not be rdaicd to the patient'* pmcnt %UtXc. Froth 
Abmii the 1i|i4, ^f lilnod liulncit prJnu io rpjlrpitjr. but It nimmrai ici 
ai4nroJl]M!i:imrijitivtMBtcsallcn<lcdbTunanBtH>iUDCM- Ma]inf>cnf« 
m twi«Uj obligrd to vm ntp for tfati purpotc. 

(0^ The tiiln.^In tcrtbnJ comprtBom tbc pulse b >Idw< ii 
'arwmU ilK hijCh leiuiaMi nuf be ni|qgp«ttve, /m m^tger^s *u4 MyOfr- 
iidi ^iiuti *f I'l |A« ^wfjv •/ njttTii#B, npjd. hill and iKHBtdkig and in 
I other cnndiiKicu A i^ ta a mir. i>f IttlW ««luc. 

(fj. Tha Tn&pentttr».— In •IK-ft«n(he rectal MBpmiisribMdrf 
be lakjen amI pattinUrljr in the imx« appantillr ftloolrallc m thdr 
BMutT. (>ne«t^c«auMOM«inkfiitfceseft Uicput adanbivkBceuid 
irUHv lurfT^i iwelti fma Om Whnv lo tc m c wWr ihel |ici if o n k 
wkd ce«elM%] Mmu u* ^ttmimlj cwpm h iW divnlud. %nd n«,T 
otcvr daring ibe «»nnarinui <*>fl'- As briotr Mnird iW ptwnn of 
|»««t docnftot Ab«i4Mflr csdwk Iqiicnn •ad il bpRxm i* cmbnJ 
lMHWttbe|ih tl« eurfMe temptnMtv Mi| vmI; a depve or man 
Uf^m tbe Pangea tk^ « t^ w fM^ywrf ddc. 

OiV rtm BnML-Am afenMir •te tka«ii tftB"^^ ^^ M 
pBV«« iliaah^iw IV encaJkd aivak b*«A b nnanfaly cfatr^ 
«c*rftek. bat dMl^ ■ f fia i baai rf W Ihai iti^t ml Aft ^Atw m- 
«twM «»t h A ihi^iiaMj iiiMUlf ffitf Ite hM ba kaned I7 
arraal r^ivnoKV: tW Wt bmA of H 

ASJUVAtt or onrftiv oouv^m svkFTOifi— PAtv 


9pcci»cm ol unnc should be rennorcd by cktheicrTAlion &nd earcfuUf 
examined wiib rrfcrrncr U> KtitHniacd tollffs. ilbumm ar Riigar, 

CoodoMoa- -In ojndiuiun h must cTnjjhalJcnllY be uid Lhtt but 
fnr of Ibfi diftervoiial poiou ^vmurabtolutdyiliDlincIivciinl there 
is iHi ooadicioQ llul nurv gnmlj uun ibc !4ill NnJ iiiniinf>n vnv 
of the pcnctitioDcT. If ibc bmth of a pAiiem «acllv i>f InufiiifiufR. 
Uic [Mipih arc contnci«rL, the brrathinR «tertf.TDUii> the ckin f^anotic. 
axl cknuny, and puikulitrif if a rcccpUclc tbat haatuMAiucd lautlJL- 
nan ii fwand cmptT, tlir |»Tiof i« Kufficrirntly cnnolutitf f^irrluroua 
bff 1fcing> fludud ci^iununjncc. ^am hdrd pubc and ihc evidences 
of pMn^Bi Aie ttfBcitmih- cbatadcri^e of n oerebrml lesion. On tbc 
fitkn hand, tmr ojirm lautU v-itk rtauf^pnt in wkifh hp is muUil t>y 
« nAVMf tf trdim ^y tynptivmt. <miro4k^ry or ti»nfuK<i findin^t an4 
4 /a>f«M iM At fart of lh4 ^iiPtmt m 0^i4nH thr man-naJt Utv^t o/ 

PAXEf - —Fam as 4 tymptam %s purfly n$^jttlh^ 4nd may be tfut or 
}4du. JMotiHd or iijjmir, mitmmtarj, Umfiarttry «t persiaimi and utry 
trttUtj im inUnriif. Iba dlflcveaccv arc intiicairfi b/ «uch dcacnp- 
live ii*fim as ffoU, ndiiog. abar^ amtt*, ifahbirgn btrnng. gnavm^ 
Uiwlaaiiftj, ahoocifig. colkky, mdiating, diffuse, etc. It may be deeply 
mipd or vdperflciftl. and imay or nuy not be wta^ated with iendemei« 
ilur viihfrr ui a<unl Inrtamrtthliontu' lo liyperr«Uicik erau. Occ««kin- 
ftUy dw site of pflui IS iar diiiiui.1 fr^m its B9UTcr^ und fntkcd certain 
rrfemd pain* may be dan^rously miilnttlinf;. tor examf Je. rbr atiihor 
bu obncrvH a cue* b whkh ad uuiiriam of ibe kft iliac ociery cauaed 
p^n oier ihe appendix, otbcn in widch appendJreal pain was refertr^d 
lu Ubc h-fl tide, jtft oilier^ i» itltidj the pniu of xalJ »i'inc tulc Ai^pcftrod 
IB llw H^aa of llxv heart, nfiilr nrtlhCng » cr^mmoner th«n lor the p*tn 
of pl emiiy lo he rFfrmrd lo the ?j.irtcinil rrpcirK i^ Ih^ ibdonnrn along 
tl»c mierciKi&l nerrt tennin-iU. 

Tlu Clunuter Mtd Seat of Pain to Relation to DiagnoAia.— 
Tbc paoa of an acute iniUtumai'jry Ai/KMC a usually a»cHia1cd wllb 
frnrTn and ollm viib localU«il lendemcvi^ i he ckfcrec ol ekher depcndLng ; 
upcin ihc natufe of iha aflectrd fdnulurv. liit iiidm JuaJ auaLcpcibilil} and 
Naiitafioev and lW Gdml aiiid tittuikn <]f the inflammalory procfM. 
fa inrtf n1 dfattirt of iht rmTmftf rt for pnmplr, tfaFfoirt ttoMinarily ' 
aaaooaled wiOt dacincll> localjm! tcndentcM ai^d ii of RTtat ^^ue u ^ 
lyn y toBi- On thr o<h«r band a pn^urrumin m&y rxiGi with llvtlc or 
no |ttin or by involTCincQt ol the plcuin |jnx)uic cjitruivc jKiti;. [n 
ThRMib tW oowtnycf Di- AnhibuM Mtt^Atrei- 


ind vtru, 






■ mnwK 



Ml Ban 

MKDlCia nUOHOflB. 

uruU txtffiuiim to th« iniffntU ttf txtfm/it hyvrt «ffvri. PHin !« UMj 
b> be diHtinctir related cither to ^riv mnfft^nt ui j;cncnLl, or Ic 
}»Mfiiona! oflhity of (h« part ufiMl'^, for nnmplf, friction of in* 
, lUmcd iuHaoo uuks raLpiT.tiL^E^ pniii in plcumy. vhHc in ncutc 
; rhcumaliiMii ih« «UghicAl movcnicnt i>l the ^cctcd jomi w disinatng, 
1ft tU such itiatftnoa otlun wtI» to rclk^vr ihr f^'iidhion l))r pnur- 
iog ovt a Urinous ct sctoub uudnto which fact csTilains th« partial 
or comptrfp reli^ of pain in fully dr^vdoprd rasn of pltcirky and 
pericarditis. tiadiaUn£ pain a num chomctcrUnc: of ncu/algUa aad 
iwuritWp and U reo^UH bj iu tendency lo tolbw Uic known diMi^ 
buliuii vt ua\x Uu»k» and by anxiftlioik with oiarkod Icodt 
om ctrlaiu anwk L>u/f ^d*<i may uk« lh« form of a g*n«ral 
as in the acute infrtiiuua dumura* or may altomJ many of dir chronic 
krtr gmdc inilimEniLtion:!, particularly such u s^S^cl th« mucow mcsn- 
bnxncs and tht ^r«nchyniAtDU!t *[mcnirw. Acuw (nAanunatlott or 
im'tAEion of certain mucoua mcmbnanrs may be Attended witli tcven 
pain, u for ^lamf'Je, Ihat ol rtnal cohc. Urw^nHg #r toriH; ^i« b 
frequently tntcimtcrcd in carica uf the apiiic. jmrunitni of tlif aotta. 
carcinoina of the tiomacb and iAilammaliori of banc^ It n oUo met 
with In nomr r«M nf oM ^tsiric ulcrr. In ff^iiT. pall nionfj and imal 

PftTOxyama) Pain.— Gall «Uinctk rrnot c(>hc. colon culic- locoinolor 
ataxia, ncumlgia aud angina fcctoru fuiaioli ibc best counpks of 
paroxysmd pain; nearly nil radLotinf; pains arc dunincily paroxyanaJ. 
ColJt. — The term cnllf af»plU*« rhkAy m |wirrny*mftl ahdomEral 
pain and includes that of hilisiy or renal nlculua, appcndintia. Irad 
poim^ing, (fouling kidnry (Piifll'i ^trs). mucous culitCa, spaslic con- 
sdpaUijti. sEiangulatcd hcmla and itbdomiruil ancuiiMn. Many of thtsc 
AlUda were formerly covered by the term "gutnlj^:k." but the modon 
AUf^GCtf) hu pn>Ten that an actual ipuiralKEa [ncuraJji;!! nf tht Fttonudi) 
i» m tan as |r> be almost neftipblc. Coac* of Hunpte InuMitoiy colic 
du«t0 4cuir indigatian. arvcorinion mbolhchiJdrm&ndadulU. but the 
utaxot cantieKi musl be obserrcd In ihc intcrprctatloii of an appnf' 
tmdy fiai|iJe abdomifuJ pain, ponicvlarfy if imduly pcrcuitnt and tatth 
diiod wftb tcnttemeM on d«cp prcsiAure. 

AppMdleltU.—Many cues bepn with ffntrii abi^mvtiU poin of A 

coAriy type and i? or 14 hours may ehji«e bfffore It bRmmes lUidnctly 

localised at a point of maximitm Itrukmcsf in the an* Lymi nndway 

. beiwoea the anterior superior ipine and the umUUcns C^cBuRM/a 

A«4LVtn or cnrUtK POtmati XTMrrCiUie — PAW. 


pmiX Tbc (enknifW novy be appmni b«fbro the poin bccoiMil 
loail^vd vid bath «re nmubittfd by o-nain j^um of rvnal colic In «hirh , 
ft vaiU okvlw bu bccooK cngaKcl In ihc Tower poilion of xht ureter^ 
NavMi Mn.4 vomftlog it th« ont/eL vith fcv«r auuc ihi^ dtaf^oAJi. 
CArvnaC ^ptitdkitis often imkaiiia pi^blcmnitiL w i^ uu)v icvrdciJ by 
opffKkioik b«t uwiallj it moj be ddfrmifttd by Ibf kitiary.bYXeoi- 
pomy Mwartaltou« or by ^ipcl patpaSion of the alTnlcrl mnnber. 
Thic dbeaic I* frvqucntly undated vkh vymiiiom* of chronic itidiRcv ' 
Hon dI ia liKlcctmia4lff lyfx. Sec pjijpr *«s. 1 

Rdul Colic — Tbta a\B^Un. inimu anJ (JXitntsm; ^riv^jmaJ paim 
□ukT nuujt fnun slooe <tr grarcl^ riliicT in lIm kidney pelvis ar psMin^ 
downward (tnnigh iJic urcipr. There may bt j^rwMtnf ncd iWaiBinj 
tMpidnoa mtfVfisMlr. It fau a m^ x ima J peiftl (twr ikf kidney poau- - 
riotij an4 tmdt i» iAaW dMMMMMrf fiver the courv of ihc [irvirrlmL>thrl 
jptnn fllonj; iho ^cr poqtioa of the ihii^i and into (lie Icsticl?. Ahich 
ifl ofMlinwa rftncled dwing the poioiiyftnu. Unlike append in tia, 
if ii fiOy ^f^Mttr Ukd d>mrM ^nd /rofuml r»iVinri^*i7ii aj£ lutocutkii 
vttk aiJMWfil, Utwd 4n</ iCT>ilW <^ aclvW ci^nli in th< Mnn/i. jVan/ai 
aod tw W ag m oomouiin and in two Entiana^ th^ ^ijrh^r h»q known 
of nuTOW eaopo boraopentionfarappciididdiappaicntlTbccitucof 
tenperaiy block by cftkidj il Ibe Lover end o( the ufr[«r. In mi^ culic 
ftiJuiiiJj U ufudiy fDiind iitvr the Uiioe^ posrcilnily. often anlerlorly* 
«Ad i» best didltil by d<rp /^iiw* ^vif tJn nth r^Jt. or MWrSimg h 
Jft« owlJbf't cr/flnnwr r*"' A>niforJ( I'L <jl M/- j^ i>} lUrp impwaUtm. 

DkU'a CriSM.— May be aModaied vrhh pair of tbc same l>-pe. with 
mon or lena ten'lenw3& ovrr irr? region of tbr movable or Soiling kitlney, 
bol iQ«re tkaely dnMUtc» zit^l ftooe cnlk than renal coUc so fai aa 
pttfai dtaD^Hiden il cmorfnnl TA^ itttiittvt 9ttii irwftfv 1/ ofia^ki 
htar btd jljf&l rr/j/im fi* r^ tUgrrt of Mnry mMHly. I 

GaU Ston« Colic. -Is Lr^icated by f^roxyim^I piiin in Urn epig^- 1 
*lHivi tfv rtfA; itjpivlhmdrium. raJiating bath up'^'iird amd daivmMftt. 
hmt chkfj •r/mnf. bcln; often Feh In the light ahouldcr [olnl and under | 
tbe ri^ acapula. and it aanndatcd with f*rnUrtttij an dttp prtttuH 
OTCf fhc j^l bfauldcr al Ihecrid uf ilre^i utAfiuaiiuii. It is acuj]n|iai)[(^J 
by MTfgi. or vamiluig and nay or may DolbeaAocdiite^ with jaundkc- 
Sce p«^ ^v>5 

Colon Colic— 1a UMCtatkn wfih miiooui colilli and with ebionic | 
i|MUUc CE;rj«ipiiia«. a paroxytmal Aliack may mrnr f|uilp m •rrr* aa 
Ihtl of many itnal colio. It ia left sided, the maximum point i» over 
th« rtfjioti of \h% tjcfaey, poeCeriorly. but ordsiunly it lodu tbit Vf^vail' 

Mat v^fBLi 



AMALn^S ur CKVUtlK UIVUUK sY>l7ttW4— rAJK^ 


opmictp and pockcUi eliU ta tW meKclcry ud gmifntum. nipiurc of 
Ibe dwptmftni. various hernhK jud adlwiinnri d ihr tip nr penijrt^ 
ttttf of, Mcf^kcl') cltTcrUciiluav 

Intetltap] P»r«l3nU.— In tunnoctkin with Al>damin)il opcralioo and 
u a K%llt u' Xltm Jtficl firrikiriiLii, llirrr fn«r be Mi c»\*K bh^iiiv ut 
iiKAlitkAl 9Ktlvi(y ir^cting !<> wh«t i« evciUially 4i) icuto vLi^iniciiuii 
A^DCutrH vrlh grnmJ dl^mvii'in «nd nK^jpord by Ihr aborofv of 
nofsul Mpunda apoa ftusmltoCkm, 

Fecal Inpicdoo,— A kad mua npukmily acrumuluinji in an 
Blonk bowd cuy be fuund citlicr ai the cf nim or itifiTi^id 6^urc anri 
M>y vlkoUv ocdude Uie lumm or <ontun h oeninii diinncl ihrougb 
whkfc ft CcrUufi aiuuuui vi wjtXctMi] ii»> |m» A liHulLacJ i^rituiuiu 
vilh pan ncd landtfm«n mtj or iii;iy ni?t b« pivstnl ^n^l thv niua nuty 
br Jtff in die alarm iif vufnric ctuirnfuon. I'Eif LunrtiiJcin tanat 
IrtqudUly orairt «» a rcauU ttf nr^d^n of U^c l>r>vr«U, of in ncrvou* 
oondMcVf^, in the fljic<^r apathrtjc, h;Fih(mfn] oi jnuinc. 

Of tumof*, Mticrure* mud occltuiofi by forcien bodies litilc occd 
be s)vi. Oofclnciii contnctiLjn nMUJu uitnally 1mm oUI uJrtn|ion$. 
whribrr syjjhiliiii- lulwrculoUL <l3racniiric or Nmjjlc; le« often fmm 
adkabn. Ocdivion by lumof may be due io dctdopmcnt nf It^col 
gtmnln. dtrm Timwir. nr ainodainl ndhKinru 

Ocntral Coaimenr F.*j}y anil mrtni tViAipHmii- t« itr rm{>rrUhic 
in ujonoctHin «itb iJiUhlia^ «l]«Trurii^>n, hvnci- the Waiiitji l(<aiijr«« 
shovbl be kept dusHy in mind. JV iicAfr rAr r^ftiUnrfji^ri fhc l^is n 
Ae mcilMrwtiif ttti 4UHU^ ttimori finnl to am mTwU grt^ik, iiM^ssm 

IflMMOaoeptioii U mni /rpfumf in iHJ'incy 'Vid (hU4ht>\ii, ottS Utt 
tmm*r It nnvily in iJu Hfe-^trr^ m af^rrndkud wtgkm m in ikt ti^jinAid 
Hamn. In tlic bXlti. **d m rtjl«uluA Ebc ImI «f Ituid caimtily vi Ibc 
\antw btmvl miT be a« imp^nant aid TdJtWjtf iji fV'<ir f>vtntan m 
tkt f^tirfk 4iatik. MarM IrwrmAj and i4innty jAw^ jt m*'U jiri[unit 
m iMmumftfH*^, liic pittE*!^ af /iWrflw /(*/ or jtroillf fXAtri^'wd tylia 
4ri£^ li^iWi nt^yr^f^ t^atnutioji. bm iTL^y mnir tn law^ of bvnE 
ImpadbM pu M Wii n g n^lral calibraliorn or even be due to hcmianhMt 
Of trt^al Spafm Furtlwr, lliMtiffTi innr mnflrifurinn ff^Ji rrlrfjfiVii 

tiiRtcTi bfidirs o| any kind mav 4^um <lAiiiii:lkin and arr vliltrn 
Mllfinierl uidev a cltiu IlixtofV u olitajricd. &IjiaI trf(|iKnlly tbc 
a Surb ivforiua imr 1^ fav^nnr-cn- 



I LfTllW 


■EiJ lurthfi. 

Tor by 

ffk* 111*11 






irEflirns ^tt chEUIrm or mcnlmlly dcfrcUvc potkiLli^ The pension 
mdfmnjstniion o( l&rffc doae* of bkmuth afid nnafcnnk oiajp ctusr 
oh«tni(^livF miittn. ami ainnagsi other rarr ;»(h1liion» Jirr bitDdiM at 
iftiatliuJ wotms. nuxues of hwr. and gilbloncn wl^jrh hare ruulc liicir 
w»>' bf ulceniion Irom ih« gpU biL<1drr lothe howrl> Fef^ PtMttiimf 
may myWrr t% or ^ hmn M dtfiMia^ Aj dtandrMc br^mmifk c^ior 
amd ipec»p< nipr- OhOntiM^m mtj bt so hw datum ^Ifihtjdlby rfdai 
falpati*n tmd in i»op>iiiihijc oJi^ i^ ttgrnM tAsirmtitm the s^Uurr 
' Quv b? rrkxcrL Fcvct is prcKviL but unitfly tBgjtkU IIUrM U nrrmiTi 
and in a few dayi oilUpsc apfvan and irrmFniM procnpdjr in dnlh. 
DUfnosiM b^ InBalioii mtxd Liquid iDiectiooB. -AnaiMc«UMdcb 
tMcMKVr ind bttfiuM 6e piuhrd f> ful] jrlDnLotr. RrcuJ piJ|:«tioB 
should be MktwcJ by ilic Intri>diii:tign oS ■ lon^ tiitic tKHlr'» tube) 
or ollcntimn ihv vM<^ liAiid miLy be in«encd.t J*^ the mjrctior ol 
vnttT which is in rvrry wuy »Li|^*^i"' ^ *^r< ^^ i^lirril should b« 
placed in ihc tnct'dwsl poaiiinn> l^if wirm vtWr injocicil und^j^nik 
|>mnurc and hi posagr <lrfrmiimi by lioih pcrcuttion And Atucit^tft- 
tion. A n4irni«] luItji) iihould hold tA^mi S lilrea Ct|tisrts1 and the ilto- 
aeatl valve uurJfy blcxLt any lL>w Into x\\f Imtr XKrwfi, In chitdreii 
ibr injcctifin may be \anrd acuunling I'jat^. Iluntul; rvm an infunt can 
lake from I to ri Utm^ 

»£h gMinniwA' ^tn; -JiundJtx nben pr»rni vunceata je*)} glonc 
callCi but ita abicnrc It oi lliile (rAiaQi|ueacv aa dji^nnrluf that diagnoaia. 
Few b cctiidy ftbtcni aa a niJc la colon ci>lEt. Ic«d nttc gftsUic uker 
and abdominal arrurism, Ll ia aimoit fnvariahlff in acute app^ndidtia. 
fTK]t]ent ]n gaJl iionc culk, morr oSitn Absmi in renal colir. Thr 
cxanlnAibn of O^c utinc should never be omilictl nnrl may fcvcaj ihc 
hlncxt ai>d :<1hiiim^n nf kMiicy bwolTvmmi. ihc h)^ grade Endtc-antirfa 
t>l ilciLN tht ixilr oulor and Incrtaicd quaniiiy fujopcatlvc »t h_v»icna or 
the BduaJ ilonp panicka of ntial calcuhia. Tht rxaminai icn ol xht 
(jLnod may tbo» IruOKjrliMJa due lo appcndicjfia, or the bnjDplulic 
granulatTon of red cdb BVggntivv of l«ad p(^»>njn^. 

HEADACHE.— Thr fnlbwing poJntiiliQuld be nmiJdered. tit.^— 
(a) Ifi^aiitm. (b] chitrofUr. (c) wrmiy* (d) JiiMwlMn, (el fiim ^1 «tff«p- 
r(?v*. (0 4tfwr.ur>fff fg) W-iif I/fufdriKfi, (hi lurrdtiary frnUifesiHtm^ 
(i) rA« riTficJ tr/ mfldiMJidti ^tn vyphiUa. aMianJB. malanap etc) and the 

* Tht onJj way U>ai h liugt nlbnonv un actpe, 
tThU ptgccdiuv i* cigt Cm un daB§cr- 




Tvaf luiC' 



put It h UKuJiv nxHlemle mniJ oiwculc:! vi\h » irox ijF picuun.tiul 
IB cxJrrfnf cMkvRM Ja eccuAocully m severe oa to roonbTc tht facodocfae 

Bilious or Drs^qiCic HcAdaicbc- TIU loxaimk- lanciy Intbdc* 
u ctiologic lkcti.tfi Of OAwiiilr'l onrlpiiriniK liUijrmia, jsunclfi'i'. ib^ 
dji^pepriMuidtomAipAliun, ll iaimicxLlof indijnitbauidv(i.^rrcncrp 
ffMllal tad CMj(0livc ib npc UiH unxuicd vrnh Q&tiHV, '] hrre ii n ' Ki-cpniiUn 
iUbJMlivc KSMt of (lubu^iiin; a ivndcDL^ Ui njiuun; \X is jultcjuh] by 
1M4M wad hj fllc>o^|c, and more or kv promptly relieved by cmois 

BruD TiUDot-^Thvi CAosca pcnuffnl faca'^chr. uAimllv tii^naacd 
■t BB|[ht. UM^ulcd witk niuva and vomliing, and Booner <a hxrw 
vrllh <ipCk. neufktt^ Scr p^ 5;8- 

Brain AbuMS.-Xkk may cause (cvere Lnd pmntvat hcodfldie 
nnonblini; Uui cif brtin tumor bui ^ usually armm[«iiW by « wfitk 
tanpcMture aifw a»d optic ni^urilia m uwAity aWnL St« p- 586, 

^eSmia H«AdAC1iB9.— ^Tav be eiihrrrocdptlal.oTbitalor frunlal. 
an UMuHy *a*idiilod v^vK ux of the tm fix doic irork. or In ccrlaiji 
<^am tot (lifiUncflL relieved by tircp and fmiucntly attodatcd with 
nnjimctiviik icnilrtncn i>f i^c rycliall 01 tyc nLU>ilc9 and Kimc-Llmrs 
with bhirrrd rnioo 

Drag BcaiUehcs.— Tl>r mvni« ai i\n\^ mny Irad i<i hndathn. 
■tiitti luve 01^ ifeliaiftibLinf; fi-oluru. A dull ihrobbinR hudadic 
iwnrMlrd with nngiiig in ihe for ort«i fotlovi the adminuFraiKin af 3 
■Alkviilr iir qiiminc in fkdl doac^ 

Brlghr* Uic«a»t. -(:^ uivmic headaiiic*) p, .^o^ 

Artierio-Mlafosfa. TIic lauaci^MAKl^i^lbTriintJt^ii^P^raliior ra- 
dUi andbf thv- fact IhatlhrEicadacbmareoflfii n^liovd by t hfmdralnis' 
tjsikoaf iafhaikiiKikanitmglyrrrinr. Tfcry arr wMom vtm ibough 1 
oAcn penislcnc; ok Cnqucnily ftModiled with imrwnxl mcmoty Mid ' 
iDldlMtlaii and trualcAl Tcnlgn muI 4m a/m fitftrunrnfri «/ fwfrnaf ! 

WtllTtft — Both dun. pemtemt headache and ob«llriaI« Dturalgiu 
may hr eooaQiMnd Ic aKiimiiuii wiih itutlatu. tlnlnn it u duttmcily 
pC3icidiC4 tht ailljr cfaan^trratic (ralurt: U iU nibsidrnn under appro 
prkl« drag lii<«tni«fif fquinjnr), 

HEcralttc. — {Skk haadache. hamctanUl- Htrediiy plnya a tarpi 
pari m nrgralnr vtaM h nicaifled by mnny 3k an r|ii]r(>ik cf|ciivaltat. ' 
Females aor ia«dl itvquoitlj atuthcil Miid a cuuaiiki&LiU ^tu^ot^^voiAtA 





Lhc c»MS (3^> rommoice In cblldhtuH (jih to idh ^rarr Aside 
EruE^ family tainl, crnii.1itiuTi& audi uc^c Vr&ln, ailcriutib. cariovs tcftk. 
pelx'ic diuAic. j^ithc rluorden, wul oi«i%»ctt«nitfnt, (nvnlud^r And 
JiFlFfk'. rrron an- mint imjiuftiuiL Thf auUior h4s vcn a nornhn 
'if (-n«ct of the man vxtremc and ppnisicni Ljpe BBwdnted «>th n rt^al 
iuKi\irtc\enfy wjihnut litbi^r »i;n!i nf ihr rhmnir nephrliin nJth nhich 
hrifJjicho oJ itiiy I>|K' arc ny fn:f|ur»lly (t^HufBlH, rcnwlidt> may 
\ic madt«<l vvm to tlir hr^ur of titr lUy, or tl naj bnr a dt^&nite juid 
invariable time rdAtiuu lu niciutniaLion^ 

STtnptociu, —llic HitAcIc apptantzKuall^ in1hefai1}riiii>niinfE.4ifi«n 
[imrrlrfi Uy kHalizcil miirbniw nnit tinj^Un^. hippiifi. TCnl|fn. viuial 
PAixsUkwu (fluhc» of l[|:ht. Iftrtifuaiinfi fix*'"^)- crampa. 9pftim^ 
or «v«n a|:Aiuia &uiH-irtiril v/ith mmTnl cihuJrhrInn rir rlt-prvi£wn 

bfffinft Ml fAonui^. Kausc^ and vonuiioK vc coanDcn tymptiiruis. 
iYar\T-mt-iitH ^lii^it amt »(iunJ incTTftjc il- tl may bnon^i' hllairtal 
iknri n^fn^vc Aii<i psJU^r or lluiihin^mAy be m^irkr^l. In u |jrni>^iccav 
r>HTnily<jb4rrwillf»« j-ftungrhllrf, ihr hoiirAfwAklngH iraiwipnl aphfltia, 
cilionc ralleasnoei niatra anJ romiltn^ luhcrH in a typical htgiii- 
cmrnu, wNkh latied (or liul two or ihrve 1)ouk Utually the duration 
ia "juf, Mjinctiiiif* two or three daj^^, a (u'stii'* Ji-i>p uidiriaiily brin^iAf; 
rclirl In rhiUlrcd the possibility t\i a dcvciofdnfc mftiin|nli» or brain 
lUiTKir muM t«; n'nirnjlu'fnl, 

Hy«1<fia. jTTvr it no kMfk/Jtf<lMr4<i^itkitf kyii^M and '^davua^' 
tiritin al Ihi' Venn iistfn nail wi^rr luring c^rirrn iniotbc 11(1111; hafirwvcr 
lK'i:n rniftuniciol by tht atilhoi. 

Navrasthentc Hcadacbe,- tmiilly mild and indt-iritrwnuk-. inr 
i|ui^nily uLLJ|jiul. i\k iin^ mi tmil ^h«ratirri«ik vi Utitiluini UiUmamin^ 
maiimum nn<l the- itiLdrm y tf> iliAA[»ix:&r undiT phyucal ncrltoa anJ 

Htaal Ueadach«B. This form i« tharacurixvd by pain i>ilE;in(LifLii> 
hc'LWfi^n thr pyn and mrnrllnu^c ttiiinin]!; hcickwanl li> iIm^ rKtijiUl. 
CivalJy tL)4.mtftril by nait^liiug* nriL-r£iii|furfitiiLf|'intC4 tvii^M: in |f]<; muniitig 
and cvL-nidji:, and nrhcvcd by any rrwawrc* rtvliicinjf ik* ci>n|^ilian ot 
rir rvUt^vin^ llit im^i^tiit- u|»n tlir na»1 ^irtKtum alTrvlciL 'Rmv 
atr cSApntJalLy Ittrhiudl >>r fn^Flnl «iiiue bta'lii.IiL-s r»ej,irSn|> fn^nt 
(^in([c*lion or >iyprrini|.t>y '*( Ihr turbfnatr Imnr* tir diwvot r* 

the fntiMf^ 

HEUKALGIA. 'I he \uin at tes^rr iicval|Eia ifla<iilr. failialin^, dia- 
lindlf lLKjiliar<l u'ld as»oiirtiiKj viilbflU|icrljidal imtnlaof kridnnvsot. lift 

AMALvm ur n^mufl roMUuH AcVMrnui*— vu^iv. 





■fcinwIcitiTir limlian lia in its dcifiiuti* rvUlicm {*> known ncrrv tninkst ' 
poinU til j?iii uul ih^ir ditiribuEtcMi. li miy aIT?cI ani poition 
ifae body, duMi|^ moat commin in ihc head, and b u^uaUv the ' 
of toutmu. IhouRh fTcriucnily imiiitcd by utremc Uiij^ue, I 
itimUrlj when amuLiatriJ ititli cjiimaurc Ui uiLl >.iic| (Uutp. Sevcrr Ci-^uar* 
EUck* at* i«(naiial>1e ^r p«raitt^L-f und intrAkitbllity vrxtUtr tf««i- 
> ■ tnidrncT In rfCTifnff»cf> ofien (jCTimJic. aiuI to chmniritj' Th* 
poJBis ip iicutD];^ia r^ntfent points of ocrrc trunk cnict]ernce> 
r rminmcp inio miuclH. or Ihdr trrminsil fiUmpnu. lUrimum 
loHlcTncsi b usuktiy cktily dclfrraincLl and viddv <lIiT(u>ed Kn»tiivcnc«i 
Af ihe most fitTfitir It|w U tunnatUnn cnonunUml * 

TrifAcinl IVflural{l4.--(Tk duukurfu:^^ EUher Ihr vphthatmn. 
upfrr m^xithfy or I/m Umef tfranfha may bf 9ffrx$fd. th* ijist bfiftg 
'■Mk mmt i^ mmtm, Uu Jku tk^ matt trtjfrt fann. In all variriiM tht [tun 
imcRx, ll>c potnl oJ t»dcnir«i nujkcd- H xhe ophiholnik ht chJcHy 
^«1«l lUc foki tt VApcfUllf u^i*rr sbAUl ihp rvj^on i:if the ryr, which 
often injodoi diKl Irndcr. Ladnymilicm maj be ;;iT3irnt, ami ihrrr 
iiM<k«d I«a4efa«9a in the tupraorbiEal rt£wn. over the l>ridgv of ihe 
. and rtcaulanaly u ihr onipm inil ufqrr cfrWrnl ipinn Trtn- 

|hc aaiLniuni podn fioltoiwv the apfi«-r t^nh iind ihr maKlmum tm- 
b al the infraorbilal tanol. Wtth im'nii-rTnrtii v} thr tnwrr 
Ifaf piai mfalea lo Iht- rar and alon^ ihv bvff lerEh, ihr 
painful poino corrtitiHifuJmjf ir> the jiun(uli>'l«niiirjral iienT. 
brand M* arc ouallT more or lew olTccl«d, and a w\vrc ht^rjittic 
inkA m>y orrur akmjE ihr ir.if b of thi* tnprrlleiat nrrvfii 
Cervlco-brachial HiTurali-ia, This variety frequently awvcialvd 
th rhcUEAiTk *flf».*rfijin% inrnlvr* rsf«:nlly tHif vrvi'in' nervt** nMhf 
fcracliai plena It u nbiivrly inficqvicnl onura iihiell} ii uromcn- 
KUy bf daf vt remote |vifnary eau»a f^^ct at locnmctar atajca, uicvine 
'**■**■"' or ciii:iii:« inrth. rin<l h iharaticrlfrd hy ih^ dlMribudcia of 
Ibe paia vtd pointii «]f maaiBium Icndcmru which mt^y be <r\<r the 
ahiar arrrr. I1 fhr rffmv, n^xr \ht wn-^%. \n ihr »\i\\x. r1 iV {nf^rictf 
aajck of the scapula otir ihe dthold muKk, or nvn en either side of 
the Inafr cemnil ipinr. Iletpn. Dntnibinia and vuomolur diiturb- 
icca may ikcui 

Carrico-occtpftnJ Rcuralgia. -Ttab affectt tb« Knitory bnnchei 
ilx u^ffjcr ccivical nrrviTk is "firu caiuf?i1 hy fvrvical CHrin» an'l uti^ 

*Thc posMbdltr of a rrniil ind^cviUMO 4) b-licaicd tf;r imuRiCjcnt rt^e- 
1^ <4 unoary «oad* *bwl4 aAwayi bf iKirnr in n^&d 


■fcUICAL DiMWOKlft. 

KUolp^y . 

r«ln mil 


— writltd wllfc * point of pwdmum tatkrna* tM^wj between tfcr 
ntfioU pncMA Ami ihc atltt. 

Other Varicti«s of Iie\xnl^A.—Inkraa4i .Vmi'nJ^. Tliu ooid- 
COan nilmotil ocoin mcit Irpqupnliv in IhojK de^iliUled by avtrwOfk. 
indnutniiiiEi, iv^jgrmU w co^jLuliri^ fliacaAo. aiKl vccua cbicflr fo 
youni; idult» of ihv frmAla »rt. |L ic ch«r»TVritcd bv nddvii p«iB 
in ihr <lir»t. uf fht- lu-nnlj^ii^ Ty|Mr. buT piligliify alTfrt^il by FRqnntioA. 
^ followinf! ibf inlcncotal duttibutioc. Tht muimum point m 
temlivnai rMrmp^ncIii tc (ht cxiti of boih doml and actriw bnnrhM 
and it dudlv aScca. Uk left lidc It U ordiniLrtl v <if brici duration* bnT 
may last wvcral wcckf stad is of iqicdd imporiancc in ^nnocctidQ v4llk 
Milium i>r(li.r]i». |v1ruri«> ah'J llic dLulc jioii; uf lELlnt^bdunitiAl dbucxNSp 
i'tr ^'likh It it oKert roistilccn, Iho ptin brin^ tiimctinife nl«rTvd to 
tnt|>frfii-rul rerve riirlin^ u|>in the inE«TLor ubrfurninal wall 
Berpcn Zoster. Closely ttacmblcs inlercMlnl ncutnlfia. bat ia 

An^rMta^ jprobabJy n Dcufiliit, It b UHL^ty unJbifrxl. ntrvly l^bfrml anrl b 
amxitted wttli on herpetic cnjptiun fitibwitt|t the catxne uf tbe iffaicd 
interoralal n«wc> Ju pain is atroiiou* and mcy fr*(*J4 tkt tmftifim 
by mimy lunvs^ 

SciatiOA.— (ScMtic nc^irhii. »datic rnirmiicui)- ht the p«c«Mioe ol 
the ordinary PilcJajclrsI itKiom. tdjulrn U usually IattUic<l hy rxpo«ufr 
lo ccJ'i wft ttid cxi'cwtvc f&tiKuc. lUrcd mjury. pnatfucr fnirn pcJvic 
ivnii.^r. cbrvnti^ (i)n^i|iftfLon ftr ptnitibnir); dJAM*^ of the T*rt*bn Or 
ipiiul (ord- h U choricLcEuvd b> u niJdi^ti m\x[. Ibt iDteiioe psSat 
ioiloyr'wg the course of the sdalk ricrvr, and oAcn fitmdtiig wdl tip 
into rhc lnmlHir tr^on. Intrrvnk of romptiratlvr immunity Abrtruur 

Pmnjunt, wltli [tflf^ivftm^ of ■ mfut exmEiijiTin|i^ type tlw [**tlr MRWlimcs dioollnjc 

■ Irum ab'>vr- d^kvuwiirda and jelling rhr «mcniEon nf un airing} ihork 

fta it rcacha tiir btcl. Subjective numbn^ea, 1jiii;liii|;. diid diniurbed 

' tvmpertlure >mi« miy be pmmt l*n«nirv a^ifili^il at ihc mJdfit^ dE 

'ibc thfgh. ixiKtenorly. KUtit notdi. ptisitmi^ upcti of The knee uhI 

ciJf, the external nuilJcolLU or the doraum of the fool tvvcftb iJie 

IDscdlAntotia ^ctir«J|*ic Paifla, P«in of ■ Dcunleif typ^ irwy nf 
COUM occur in nny ir^on cf the budy. im<1 be confinofl Id ■ single 
tniak or even a xbnlc tcncuuil. thui it may be timited to thv btcatf 
imat^ynijii, finffer (i^ifiArJ wurof^). the plofLlor nervc» (ploftUr 
ruMfiUgiii). tii \a- AA^Hinn-il ^tili ihr Mrtirtiln^c of thv pljuitar lIiExnftnU 
m incipeni i^Jil f^Kit. 't\ which cMt the piiin U fn went tnatancc* ltinit«d 
to th« Ihinl arri loufth nnriatirfr^'pbAUn|crAl joinig (Miinnn'a Foot). 





LBmbo^fadommal ocui^lglB b ch«nrlcTkc<l b> pain In the back, 
and lo^L r*d[at^>; to iht ^^niul ^nil hypogutric ref^tmt, 
d anw nf rufrrficiai ^mttmni. It i« ninirrukuly jiMofliilrrI with 
dobilily, chcoai< coiutip«iioa. dbciue of the pelvic utkuw 
d CTpo KjP F 10 u«t and <old tmder coDclilioni of fatig()«. /h ffwurral 
mrt^iia ihc jmh U GmiLMl to Ibc fi^xit uf the kocc And lh« outct frioiil 
ol lite lhif[h. In diicuc* of ihc hjp Joint the rcflc;? kncv pftin (inner 
) U rxirvRidjr coraDMn, 
VEURITIS* — TIm duliifcution of npvirilic pnina ami ihcif f^cral 
ifciiaumtali I Afc much the amc as niruniljiji. ihitujfli mndi matt 
MTcre and ptnutcoi. The iLkasc may be icou cit chronic, drcnm- 
«cHb«d Aftd lioulfd or «tdc«prtftd lad multiple. Diiiinctly in^jmi- 
b type n tc«d« to ppudutc primarily 4nd cssriitiAlLy a dcccnc-r* 
of ibc «ltccied pcriphenl nerves. Aiif^c Iroro tbc mon pfrntiftienl 
d toiutuii chmclCT ol ihc jttin. thr riqukllc l«ndcri>c?M or prmufr 
dh«Bd«Tutic FuTtbcnnoffVi thcr? is a »p«dol tendency to marked 
Dotu faypefvuhem followDd by arutsthrsia ud «ueh maried 
u ledoai Of iJL^lur- cdcnia ur iditl ftneUbiK And berpdJc 
1q tlw extMAnllie* th« ekii) olteik b«coB)«a ehmctftriatkftUy 
amy* vul di»tuib«iirc» i4 mitntbn «rr indicaxcd bj inuactr iklrophy. 
mdJon of dcKtnontioa. lo9» of dcpecduit rv3«iM. chuif^ in ihc 
noih. Ion ol Iwr- di^iuniatian ai the cpiilrrmji. ric. True vvrrillng 
the nerve trunk uid erylhcm* tadKulinj; itt oouoc iCAy be proeni 
d If Lht rodvir ^brcf) arc AffrciAl, rhani^rt apprar. Vftn'lnR from a 

(if UUjpK jwd bIjeIiI lc«a ?! t^vwci t>v ai^dJiil |«rBlytub 
HUSCOLAR RHEUMATISM.— ThiB common and gainful lilmtnl 
oAev ftfJeds Ihc lumbar muado (lumbago), mm^l^ of tbcf dial 
thecernoltniMcks (rheumatic tonicoIlitV Id ill th« chief chanc- 
Ic h pnfa «tt moTenirni. whirh fLmdurtf* morr or Idu chftnctcr- 
c aliiUsdc& dmoit ueenpktc 1q4» of lucKtl<in and vuUmlwy ri^ilfty, 
oJ tW moM in^ioitJUiE polnu of ditUncticn n« h<*iflrr«n ihie p«lnfid 
of Ibe muBck* and neural^i. nmrilla, plcunay, and auch 
aSeclnas u il nuy umukte. lies in the fact Ibat tcndcmcai of 
Ihc anuda Ihen u etie t whirn ^^upnl u a prnDtinrni feaiuir, ftinher- 
llie pain ladiitincily rclmd to oaiUpCLiIfir movcmtnl, and babecfil 
fp^ady fliB*Uamcd wh#n i^e paiSmt (a it n-vt. Tli'i dlasaa* ia 
u&ihf«b(cdly do«dy allied t^ thai Sana cd rhcurnalum wMJi chic/ly I "***' ^*'" 
the tiMdova and In many ca«« originat«a In tbtwe ttruclura, 
OoMnieDt.-'ln gcnend it inaj be Mid of pain thai la the 
nujoriiyof palniulailrocnbthCMnlof pain rcpreMr[Ut7tckt^OT\m\ 


1 tndem« 






nniciu, Dt^oKotn. 






mattt lLn< 



maty the localEon oi Ihp ailfcifil pan, an>1 &Tiy Attmnpt ta Ua the 
cAormous raricty a faiilc artd ukIck. The metre imporuni referred 
pttlnft ifp drvrlfaf^fl undrr the riivatnof ihc diffrrmi arjsMkt- U ihoald 
be nrninnbeiol buwcvcr ihat lAuiJicr ^»^n ttiai he Jur to louil dnnttc 
oi \h« j'?inl. n^urxlgic rfbtai* ol tli» diajj}irj|;;in (t l^t^xunM of the oahn, 
uipDn ^c€torh MDd. on the right ^de t9j«d>UyH ui iiLasmmAliiTy dbt- 
coKi of tbe liver, duodeoaJ obsnatk utd laovablf Itidacy nr ipill ilDCtcft, 
p4iM at lA* inti^ ^1 lA«lwwnt|EpttMp Joinr clw«w-:i1nwn ihc fnmt 
^l Ike iAifib, DttrUa and ir^ljcuUr dbcuc or ^unrtinitii ■ ilcvdopjoi; 
fviDorat ^r toguinil homlfl. Fain n^iaHngU ihf jnUtyf jV jnfnorbo 
ihc ticstidt i> UMnmon m renal colic- Hmladics b»rc nlivftdf been db* 
raised Eind Ikt atttkM is nvi MwntKtJ Ihat they tsuf^rm ta «tty orMtar^ 
tlititifiiatu^n Oicorjing ic toatthn. ihough mch hju brei) miumplrd. 
S^^crai and midimmhar pttin b, frtquct^ih of tilc^rire orljEln ^nd 
kidney ofipn jtiwIiKfA j^ pimftil iutn ovrr ihf ufmv-iltic joJtii. 
ria4c*< nnvjiinJ ^tjhi iadJutin OLici.79odvniA but eitujiLlyaharppftin nnjr 

mdkaitei hi^iMlJt: luiani !f on ilie riKht sJilc, ^tplrnit ifim ihrlrfl. lawtr 
jMMnitdJ-fHfUJr^nl ^rirn *U|e|:tvU oiluk «iKmiiid irritation, npprnda- 

PnHe ^iffl b <hiefl)r altribuUblc lo the pcUic orguu and c^ 
liti& I*l«iiniy and it* referred }Ain« mtv [liKiiMfl eUMvherc C^'- 
guiirit piin ixivtn duodenal ukcr, apfiaididiU, k^^^ dLsevc, 
[ncuruOs dUplftcemrnl). por^nuEu; Vid vcrtcbnl dbcMt^ pivurajr, 
[MifiiinonlA, eic. Thf j^lrtUf iniMitifm conforms l^ tlwwalat line ud 
nprcKnla const lidion rather llran ;*ain. It pointi to injnrica or lumon 
ol ihr 9|unal eoH ami iit mmingn. chronic myvlilu and booanMor 
ataxia- In ihc b«ik ufrrjcg^iJar p^ini Uoflea traubloniac and neatly 
ilvniyft indicale« mf-re tndtfiection nr Batuleoi dJtIenaioa Ibrmigh iiuni- 

' riiin. itatlrif ulurr and raricfi mmn noi br forjrntlcn. Mfdi^» fiUtt al 
Ike Jtkmtiiifr Uvri mav al^awmir in nnevritin* pcrirordil» and i^aFdhng' 

. made irTital]i>n V]ftt of thr Momach m;iy prmtuce ■Bfrfiair paim bvrr 
i/iTiKi'ttiihUndfrMvtoLhelcftofthcsfnQCovn-ihe loU^ aad iilh inkr- 
tpacM. A iMdcd colon, vpattkconuipalipnornmcauf ooliti«iiiaypR>' 
ihKK diaircM (n tht aame re^m. AaJdc from :heae laonrs hatkoJit^ 
uraaily Jow tkrwn, ma^^ indicate ncurMtht-nia. f>«\*i< diu^M, eiccoH^ 
raiigui-. 4plnaJ nrfca. rvnaJ disraMCkiin nr-irinrsn U eAfcriulLx o?minori)L 
mc>e«a£T« vcneir tod variow other ccndiirona. Pain in Ute fwW majr 

I be due bn ftdaUn. ^out. ovarian and tntirular kUmL inin-abdoniEnal 

! pvath or pnirtatic dUeue; CmarW acMivf ii a comm^ii srmptom 


o< ivrvodft ftoJ muoilar ilvbfkhr nr fattjciie; umttlli} pmvfle* ihr oTutct 
of acule infectBdu* ^tVoUM* vk\ n mmmon tP cTirvniv Hicum*tJAin. 
iriduiUAfif. >CUTvy, TocccKNOr atUtfti (pMio-inlM&niLl nr bqulS<- ilW 
CUfJ UldlAKRlU. I 

TENDER1VES5.— In i^cr^, irnJrmfst is aise<iatfd MiJh pain and 
<«i«;ivmj rri ^lilidn fu Jfiw ufYun ojCLirE', Oiilf ft kw iriiiniriAiii uiiti' 
lion« will b« notcdn 

n» Head.— A lFf)Cl»Ti»lf^NKnttSy|i^^^I^ hyMrrin rhriinijiiivn, 
ncunlfH uid (niKnunc. Tendemoi of the nv^op ^rtf dcumlpc ur 
uMrvm diMkir; of thr mAJciDid pmfna a mnMrntliEtEC. r^iKCrmrji <ff 
nW kui ii^ aW nmi, uiwf md nriiixtiljcrLU; ^/wit/ irr inkirnpkd 
tp%n^ irM4tmff$, ncnrvuhtntt. rhtumunun. dtict. prrkwiilisp «clufll 
spiDAl cSwisr md brMcm, LumAar tmkrufi^ h u^rrumm in ^ujti< 
bflflo and wflaipniiiigiy diawar of niaicd rntra bbdoEniTiiil trmc- 
tuns; ^M^ Hflvimeif in ■ilnuaci*d thomcrc anruhvni r>r piotlirror 
mcdiasUnal Iwnon of unf kind ^ kttdtr stefunm or ri6i sujCK^ts 
ottitl* or pertocikto; afiiATwJnaf JrW^ni^Ji It MaTrd in all acui« and 
iman/ dirjini: i3btaH:« uf iht; coiilAuinJ vistrnL juul If 3tj[rfrridal mjkj^U 
aconlf^. rcf^rrrd pir-aritic pun or hy«1<na. Ityp'i^it'ri^ $fndfrntft 
Ja unaaUf ilirnnTr rrUicd towuienr (hruAfcinilummatiiKi of thr iiii<:l4-r- 
Ifinn ttnictum. rA« ffndfn«»r e?/ sciatUti Eikc il» piin occur* ducdr at 
ih« ariavfc noidi- tht middk of thr ihfjth and knrf. thr ajiklir And hwl 

/mJ fcipJvrveu b oflrii puuiiiiK ind 3UextM» rlitutrutiintH arlhHli^ 
defonauii. ^rftorirk ^u1 gi>nr>rrii'Pa, (utH^n-uM^. trpdji. hytlrr^ji nr 
iioniir tfirmin aciunluig tu tJir cunrltiioii:^ tlvvrloin.-j] bv ihcizse Liirijr>. 

PERVEBSlOnS OF SBNSATK>N.-Pafi«etliesias,-Thr ^i:, 
tutfaaiic«9k of ncfwulan ta dcnnminatol mny be wholly unrdatrcl tn 
orjBUlIc dUcuc of lb« IhbIti oi cnri Amnrijf^ ibc more (mportant arc 
(t>. Stnsitlons of b*at and cold— Thrso *^^i«ftr^«i nniTAA^h^nin, 
malBiitriliDO and aiuciEua^ as well oa hjvtciia, klcr&l Mlcroaii. fyridK- 
omyelia tad lootmoior ataxia- In profound loaarmiu vuch u a]«oho]< 
ban or In actio] diicuc ci \h/t card lltcy are luuolLjr curnbinnf wllh 
ollitr panathcaua. Tht dutnbuTion ma/ be ^"^prai or Tocml. indcf- 
ialif, at rtaaij {Skt amn^ronuui with a a>l<i nbjrn. 

(fl. Pon&k«tioa lUtd Ilchjnc- Itching- may be pforounocif in 
ttp^mi. orunailkcnj^ ctroriic ik-ijhi>livn nr grjtjt, I«ad po»r>ning an<l 
nriiFUa ifiscuca ol the oord, II b almost jnTpnable hi jnundjcc and 
one of \he tifina indjcalins lliv Ukm;; of mgrpbine (no«c rubbmgy 
Ikali JirUnif and b^rmiakfiim ntay aau.-ilnic or Collav on afcpluy tnd . 
Uie laittf ti a comjnan aympiom \>ath u n mvU of ftct^ul ^Aa)w%. 








cora. UfjUralcat <oc»inivn Ana pcivic 
xnca. (j), irtimbtiMSflndTlnglfnf,— C}ftcn4BKKEai«<lfrith(li 
buriin;e ariiutiati ibuc svmpiotni m rapmallir t^nmifln in ooimeclioQ 
u'lih neuritis or prrBurr irntntion ol ncrvsan<l ttKh dnigtu iiCGinit«> 
in odiliiion \a ihr okU.v& of foimic^ilion nnd itching before mmtkified- 
(4). OpprcMJon. PrccorJift] cpprcuion i» common in Tncdrastind 
Mimnn Bnri rartiiar rilvav, nn wpII m In rerriLin jitilmoinftry Innlnat, 
la hdcmoplybu ii nuy JrxAlifc Ihc pro<.t» md either i^rcccdcur Accom- 
pany the hrmorrhagr. Epigu Iric oppnruiton mAyAl»^ ht pnvrvt \r\ Ji«- 
tjur.but L> moiT comnion in ihc funcEional ditoidci^ur m turmatcmau- 
J^f^^^^ cun^lrktum qt prcMLire i£ nlmcst mvurjablc in hy«t«nA or n«iifu- 
thcnJA Rnd privk nppirpvlon eu* "hmrlnf; down". U usufitlir Hue in 
actual pvlvtc <1jacMc or in the mole to <iiM«M9 of ihc bUddcr, (5) 
FAlniiiMeaDdSUi)tingS*nftiitlonft.— Ifi Argina prnoris ih«v ra«m 
uitli wcrv ptiia on aguni^ng mid terrifying ojmUlivn. Lesser degno 
arc c^mnwn in fpi^ro intntinAl oibncnlA (chiefly functional), in ail 
at the (.mnUac diieajcsH in ncuniiilhcnk, hyAcrin uid cspcciAlly in 
hypochondriftAit, ^'yic^^ or fAintncAt nuy he purely n nerxoui 
imjiJfifilafion. ft^rnHirn*? irlalH fo pffuliar vigbH Kiijnil» or violmt 
cmotloit, or it mayiugE'^^ Actual dixAK of the hcajt 01 bWd t«j4c1s« 
(oUov the nfiiiniion of udtvi or plrunl midiilcs, dif^t hetncrrfiage 
i>r tuigii!*! ifjciiLliiiii, t^t loiuh fnjiit imjit, rilu^i^Mn^n* \ir^i nr ihr iiver 

adffliaistnti(>n ol i^rtuin <\nffi (6). Hc«t «nd Morbid Flu£taiQ{. 
^^Atigue, nfrvous rxhausiion. hyHirrin, \n-Uk i\bxaae and thr mcntv 
pause Arc the roost frequent CAtucs of duahinff (hot flidwi) and b 
certAin individuflU c«uh!|«b bliubicg ia a tToul>le«>Tue phcnomenoD- 
TlkcioaAAliuaofqiiicAaini lKutknc>wQaApynjaiAii frequently AwixiAtcd 
with & tniM of eVMAjvft fulinct< as dnitnct fri>m Ui« pnMurc ien«Allon 
iHWioualy drKribed. ll a niuiit comnKMi In \h^ runciiuEial iJulUrb- 
■Dccsof ihestomAchacdin fifitulcnrc. (7)- Subjective WoftkHMti— 
In hyciniA *nd neumithcaiA or in meitr tcmporAry bnin fig tht pfltienl 
rnAy c^xpcricncc a aaae of pMltJ^c pbyaiCA] fAtJjfuc or. In the lomicr, 
puudcypArAJyIfC cympiomi cither imtiairni cir periifltcnl. In iitim«- 

' theriitt the "eAliniuiluii' may i^niirdy dieniipoLi under A^ljve atiJ 
tttrtnuoiK exertion or be forpjiUn m the interest exdicd by x good 
ptflV or a graxi Ixnk- It U frpquoiily doc Aim to the ovenue of lea. 
cof!cc And lobAcco* cj mvulEcieni ikc[i. (6). Globua llysterinu.— 
It A (pnonTlmi of <ibcin]ctbn. corwfrfi^don. prruiire. at tirkting nfened 
lo the lliruAl. is cttATActenatic of lijnilcnA \n4 may be auodcied with 

. trooblcMmr ftpusm. 



IHSOMfnA. — This imubteMHiw vytnptnm mmy ukc the fomi or 
fanabflity lo tlcefx dlstufbcd «l«fi, tfuiiite dunoi* fJevp. cartj wiihig or 
fimlDQigni vikrful |H-Tk>l4 Iti ntu^n arr irni wiirii^l Tn [urnih futl flk- 
<«mNi tbnr. Tuyini: m tbcy do Iron mere I(nit>oniry ticrvous ciicjtc- 
mmi TO airttnl or^u&c diMAfe of the brajn, Int^tiin^ ihoLiM alwaj^ he 
dlicctcd CO the condidon of (lie Monuch utd boircls, Lhc Jtmouai of 
menial wotk done, anoiiat of le^ codec, tobacco and dcohol ooo- 
iwncd. UDount otf rxmbr ukcn> llic pn^r^nc*; n' any imuitual wUfCa 
of txvTf or DKtitat tftnin, «cc««ut« uudy ai nijcht lind. the «^ of t)w 
pBiimt. Old pcoptf an* as i niLt. nriy w:ilifr> and nrhlWrly li^il 
tktpen. the condilkiro of childhood being rcv«rKd- Ftcquently a 
•ffi^ nodtication io tb« die:, hixjm of mvtU. rvUiion of «xerci(« tn th« 
OMftK liar c«ttini[ off tA cjuxun of uij kiad i^r the rnciv adinbsion of 
fmh tif At nlfthl 10 the itoi f jng icon wtil put an cn<l tci the fttuuk^ 
If nounsthmia br thr cauw nothing sliod nf a |>Ei>li}riv;td rc4l or rtc- 
rcalton cure b of any tue^ Occa^iianall) <:timaLJc change alone wUI 
prwkm ^trp and pfrmanmtly correci thr disiufbanre. In aruU dis- 
tojti ibr ttaitjtmt it] tk^ U SmptjrUint itrvt ^/Hiili br tdtilidiy nokd, 

VERTIGO. — Thii u i» moM inidan'.Yf x invi»l *nd tranii^ry nynip- 
lon ibpetnlinx Ufno iJDturlKHicrs of iliiccalnu or iirurast]ii.'iiiji. Imt 
oeverthdcs should dwA>ii rrorivF cunfoJ aUcntian, In thv fouitg \ht 
caiam are uiiaUr th^inl and ronovablf. In ^ midctk b^I ond old 
it b much naoic ai^iulkanl. The ]inc«of in^cstiKaiiun indicated ore 
aa fobont^Tho Kxiifeiut of A'ljnufjb/nM, ThSu condiiiorv rover* by 
faJ Uk icicalcr uunib^r vf la^iL dfooiiaiol as il u wirli dii^^tivrrUiiuUc, 
«y« aUaiv, hy«t«ria, Eithaimia. ueu ol naKOticn or alLmulanicb *tc. 
If^aiim'j />uinutf. A amditian lupiiuKd lo be due Id divaae of 
Un labyrioib or lenu droikr tuath ojid chonif icriecd by tfcc A^aodatbn 
of fCftlfn 9flh iTRnhua anttum and a tendrncy la fnil to ibr right or 
Irft. Sor p^ 56s /Irfrrtp-^rArorii and CWrtf Z>j»oir^ TUa rmlico 
cnwrt ibe pMUT BumWf of cmm obwrml in c/dWy /w^ And 
ia inporhMii u rebtrd Co hrealencd apupkayp lu aiifiiriun. aiunit: 
ngor^taiMNk. other cardoc Mona or cvnrbral diiturboncea due to 
other caiwfti. .Simdrrli- cr Heaislrpi^. ^tnetimn Xcavc lichind a 
imarked vcrtljcbiottf Icn'leocy. Ey^ Skinn. Fm^ri i>r refraction aM<i 
ocular iBfuOklnicka ^"nM be raivfully invc^ri^itt^d tl^tUpiy, 
Vtrti|!o aay be dtbrr an aursil nunlftslatioa nf major cpilcpaji or 
tvproMBt M altadc <l petit maJ, Th« Habit*.— Ir rvgird to Lh« uae 
of lea. toffea, tebacca alcohol and ihe qui^tiuii i>f iciujJ cvcca ibese 
ihooldbr canCuUy inTrstigBiod- Sr«n Junu^. cerr^ro/ tyfkUi$. to^- 



mux. m 







iwtor ataxia unA Bnghft Jiic-aat ore umic of ibr maxij ojndkioin» of 
vhich vcTtigD u 1 iyinfiir>m- 

V«rifitle« of Vcrllxo- - WriiEn U uiiualU ^uibtm In omri nnd Inier- 
miitcnt or ^KrimSk an lyj*r, l» nav t*l!c thr t^nn M » »^it>iociiTr 
WMatsin iif whirling <^r falling atiich inTiUt? urrlh Clw <»>** c4oMd« 
or it may occur onlr ^cn looking nt m^vbK ofajpcto n'din;^ drinng, 
twiiving. Iff Kurin^jt It «*uallj- diwfiT^urs or 1% Rrraii?" rditvoj 
when the (nileni is \y\njf. dfiwn, tiut tn vtme ms:Aiitr>, and nolubl^ Itt 
Ml t^fitrh-idff<4U /JrfH »f tf initfiiifJ by tyin_f /nr«i. Vtry otivn i 
«udclrn <haii^ from ihtr rwunjl)n« r<i ihr rfrci inwiurr jirtHlDCTA il. 
and h may bf liniii«i tr> the c^riy mominiE houn, 

PotllH 10 be RtnxttDhtnd.^P^.Httnil rrrtigt> mtt S^ufUf artMi' 

XaHtm aj liu fuofl and hioed vttitfh. thr annt. ikr NjirXft. « kiaofj stf 
tyfkilif.ttl fttnxititfpUipty^Mj the aympt/rmx *•/ htiiin tmihtr iiuiitdittgm 

DYSPNCEA.— rjb^ Irrm "Syipnao" itumtJ hf Umiifii t^ tkoir fa/not 
Jifiatlt or j:rtMiy a££itenk4 mfir^titm in u,'bkU ik^rt U mmJS'itmi 
onddtiAt of lite hiiod due rithcr to ariu^l otxiArtJCtic^n \n Ihc frci^ tnj[Tva 
«r cjcrnA i>f ait. a (limiEiisliixl ^Umonarj nnra. vt iriiiiaiHiicni uf llic 
ch(iiu<al nt^ngw of chv L>luwl 7'jbf term *'ai4tirr^nt ttt^iikin^*' 
shtuid (tfcfir f4ktr vanfiUs. rKipnu!fl may bf iHin-ly luEijniiitr. \vxx. 
^a UBUftUy both Aibjcctirc and o1j)^clivc, aii<l U RcnernUy auodair^ 
irilh ifLfyJnff dcipres of ryanoiib Any mji'liiltwi j»f¥Vf*ilinj( thr Irrc 
tatniKC y>i ^r iww \\\c luniE» aiII caUK il. k'lKc il atxnmp^itk^ kvoc 
^uiA«y and Ti^rtrwp'm^ or tit-n^mft fil ihr i;]Mli«, trarb^a nr brooM^i. 
vlicLhcr ihi; OLiur bt dircti 'jLaLniclron as fmni tumurur furrii;!! bmlks; 
in flMMMliott, Q* iff thi; mac oJ btynpeal diphihcria otwl broncho orlcrbar 
pneunHHil«;ortpciAn, Axln croup or aiThnni- Oihrr(3»rviirFrrfenible 
to drcolitorr diiUirbonccA, oi^c^islly l^jm: nf tIic <Liiijcciiilal tfpCi 
nr lnt-j^m|in;utl-*H mEtml and irScuMfnd inlonk in \/Hkh cwh ihrmndK 
liun it Ijicvly unc uJ pulni(^dr>' bIuu, ihc acralkin ui:a> bdriic n>>m«l 
but thi* hlxA cumnl obtir\ic[c<l and \\s cbcmicul nch^tngt^ diminittwd. 
Id otliFT iruCAiiciv liatb facicifs arr otncvrard. ut fur ruimpit m rmphj- 

■ In A tTcvnl catf « p«r^ftcnc vmi(^ wu lvdIv ni^lainablr ihrou^ Lb« 
hkt^ry of a mtttc acf idcfti, |)r'»fut»lj ujUKisicd n'eih tinrrrt»gTii*rd fFAfture 
ftl ihr tovrif Ihr Uult, an ino'lrnl LlnuVl |nrR<^itiTi ^ tH' [lAttrvil fin4 rml 
ilrvrl^iprd ti^' ilrr Emi ^ximLnubcA, In Mnuihi^r ^1i.-fiitri<\ tyndrciinr vat 
t>mitit ill nrai \ui\ Ijvl aw^Monl uilh nTiifltril tiiiiitllr f^r ilhtu^faaACc, 
%-«IvuUr trwigc UPil {jmlnund nturuihmb, anil Ui^tly (Uwfificaird dver 
a few Hrcka. 




VA whrcr Ihfffv U boUi pulmrmarT nasi« ood iT»ul!i(tnit air ffxchan^. 
■Aid lo 4 lev dcfEKc (ke nnc condiiioria prrrftil in putmofuify fibrosu, 
ilic prcvun of |ikttnJ and pcrtcwrdiftl cflutbn and advancnl pulmooury 

duiktil QiHn iT£cti[o[i. In «cti!n^ anxmiua thr irDpoiicd lu^uu^|obul 
CDiUffkl vhac 0i I (Mnbiaalion of diculnlory and h/ttriTC msulbdency ui 

Stertorous RcspmidoD. -In profound cnmiL cxicn^wc pott nnul 
uWnoifk. IV ffnr^llj tnUntEst toniiU js wU ^ in rinljnjtr^' dorp i[cir\i 
in <t'iU^ Mii|i«rlujb. llnMc i> d MUJjLuj; natt^ifdliun nliii^t U nul liuiActcr 
a tra« 4^|iuva ia muvl InBtSkncn. 

Stridor. —Suftlubiu bioiLMn^ n invjifuibly of Wyii^Bl «nj^ii anil 
usmJly due lo vpdAin, panlttb, cdcm^ fctf^'i^^ bodie:^ iDcriiLbr«nc, 
fimor or vi-m JaOuntruitkifi ai ihc flloais. In crrtain mvt li n-jirc- 
ftcnU proMre and itsuftinit «puun tx partlym oi the luryriKniJ oiukii- 
blttr* o fa aarurHm, mlarpd bnrmdiid gUnfU nu^iivc [tfncarrlial 
dhukaa^ dr. Il b indfiryl bjr ibr "En^wiiig" ol a iiuupy iliiM, Mnd 
invttkbXy rcpfdsenu tn*e d^-spn-ra nf iJic obsCrurtiTt of «tnnfi< ij^pc. 
lu iliafcniwiir fralum *fi' Mridnt arnl .i rimnniinrrd ivrtinii mflLc- 
nicnl «' ^G Urtvi, llw ikiccnL in iftipimtiun bcin^f r.fic(itimc« h' jfri'at 
aa UicttihjtfrmM ibr «ur)0?on in trtrhnnrimv Tft-* hrm:MiHj^ ri kf.fw m 

Air Hung^, — rhii |«<.iiiar lonn of dvipnrt^a is bnT Jlliulialtd in 
dbfjitft MKTiA Mv\ Ekv ilcv rilmt ^' iIk nnmr dvrn. 

Dyrpncm on Eiertioili 'Lhii acci>nii>AnH?i »ovrc i^hmnit bnm- 
rhbbk rviplkTvrmA, early lubrmiliubi. pjrnml rffutjtm ol Itir birni 
type ancrriaik rt>Mu>tinE iti*(jL><?i or i^djiliiy. obc»ity and imperfectly 
c«mpCRU](^ rjmbat- bsiiirifl, 

PafViatoDl Dytpncea. 'Vim jJidii^u-i H-itn-i ura'Jn of ihc rumlj- 
liow ivriliooe-l in th« pr«c«*Jing |MrHj;raph- itvausw of Ihn ur pas 
jfL> nr cerUin luobund l(Ui«nui:i- It b puticulAfly nurki-j tn 
oJntnKfive kwauh uscninal cardiitc irLOaivipcQWiiun ajvI atiwiccd 

PftTOXynb^ Djf^tKM- Tin- ■i«iUBK>nfX fiinn^ Bfr itou|i<uid Iruc 
a>jEinia. rW ifOf Mng an intpirninry ilrtfm<>:u. Ibc athti prv^lMiinai 
m^j dptrabxr. Sposna ul tlic ^luttii qnAy bv a»uiialc4l wiUi hyurria 
or u«xaa&c mrrvoiu riaKftiVi tut tru? brx^nrliial aulm^d nuy bt |icdp(tly 
■JiiiHlilcd by 4l)3piitcic |«iu>^wiift H>mrliinr» ril^itciicil fn utiTiui;* xr^il 
by a patoijvntti dy«|«»it« AiEwnfeil vn'lli raj^liac IcaL^ta (ot 'i^aj^ 


-^Hf mu 

■ luiiiv 




I >«fn>a 













the Trm tarJiac aUfima itaouM he iwrvrd- The ordinitry fom 
c««oculcc) with cArduic ducjLX being noa-panujviu) uid taumHy 
xurrme only un^cr nrrtion. af xhc prcvturv of >r«ndtiy inQtudatC^ 
?glIuji<.uU]ci1 tiiiii^>rk bcluw liic jstoKtb tmj tauw <icilral ant) eveo 

AbKfciated Cliani;*^ '^^ the Cluust Outline.— Crruin prtmnnail 
chtngts mich a* tbc lotted imrurvtioB vjpv <^f cctpfajvcmiL ihc v«ij- 
Jatortf/ caJnrfrMaif <if chronic pifumi rtfusJcm or nimfv mil the Hitif4J' 
rru/ rrJrcffTJhm nf fibniid pluIijAlft iAil plcufil Adliai>>n tind no bnbvv 
dftrrij^lion brrr In Mt^min tha lowtr diunft«n «if \ht ihonu an 
especially incr««jfd dviing ifae pan^ijram beouv? of the cxpioLtotf 
type of tbe tpoAinodic dyipnfra- In broocho pn^^mooia and ethn 

tSor\ ol tbc InUnpftCi?! or^ urn t'CimiAc tti iTic iii^iitrvicrry nt-j^iivc prn- 
■an >ncl ih« lUrrcl dntgrtf thr di»|'hnif^, Tbi» nr«] ao( be cx^nrme'l 
mib tbc HligbUrcDJilractigDVDinrtimncibacTYcd in cbrunic emphysema* 

' ^EercplOKJii ind ervn lq noncn] in<IiWdu&l& 

OrtbopuoM.— TbU icnii rcfeu ajiedoUy to ibc slttfnjf Alfirintc 
nrcc>8i(al<:4 Tv fitn^mc dy»pnoe« ^n tbc rccunEibcnt pevCurr, and h 
tnmt romiTi'^nl}' n^^ifi\ in atrd1«r inrrmipenuiion. <ir oondftiov pio- 
dudog pfwune vriltiin the mcdfutinLini- lowroeinatanccatbepaiknt 
mu£l not tiTily iii up^ bul ii mcrr eomfartable Icaninit forward.* 

Subjective Dys{iii(£a.—TlK mere jMfaJJM of dj^mcA b pracll- 
calty Hmitrd to hyiierta <ir ncuntiEhcnfn. and even Ibou^ ortbopfica 
bf prr?ml ttwtt Sa no a*u>clatf[I ryanoRi*. 

ily 1* common in rbildn-n »be(bn Awal» or uleep^ II aUoiqipeaB a» ta 
irmirwui liit in inA»l^ ceTcbnd «popJcxI», br&in luiuar. mcnlDchJ^ 

I sbock and «olUp«c, and nai infmnu<m\\y m a 9jtnpuim of chona. 
|arky IfcMplTaUoo.— TlLTi nuy be inttjiimrfy u tn hydrapbnbia, 
ajlhma or byjlcrin or expintory and o4lcn f^mnlin^ in in<erc<ata[ ocu' 
ia]||fA. acute pleuri^. rfb frartum. sEaT> uYmndi. rniAl nrnl ^1 none 

' cdUc 0f. '■* Iftf prtumtt o'i any ^k»jr>fna/ pain tipttinUy oj fk< aide- 

MM". Wai^y ins^faUm cbamcieriod by tnund^lEbwy movefntntol 

tbe che»t niAy be uvicd in aevcrt 1y;»buid< ]jiict)iriuni& and other <tm^ 

tiofls u»odat*ci ivith grtil prcttintion, 

Biot*a ResplratloiL.— Thiii lemaiiplles lu mpinikm ititfrreptird 

■ ti hu b«th Mtied thai ihU lUUf pwci"! iapAthnf^jTiAnicAf v^uir 
MTlitit. but In thft *ud>oc'* pr*vm*J upnttnct tt Is a mmmfni tymptnn 
in tncdlanint new ptwf bn. 

AXALnn Qt rvMrroKF— KrsrmAtoitY ftsvnm. 


rcfCuUrlj tn intgubrij bf apaak intcrvtb of VMyins kx^fth. In 
s tnodtfttte lorm il aity be tficounicrrd m pnrurac^iaH but h cudjnonly ' 
■ pfnntninr ci dmih Ja » jiIhu^ «ff#afi>iiA. I 

Ch^TAB-Stokfli Breathing. TtiU covets al»o irr^cular bnalhiaR 
inlvrrapM bjr aimrrir intmsiK tiut duncienj^rf by fh? f^d ihtl* 

tMRftHAi; in ckptb ud Inquency unlil a maximum it rcacheft vhta 
Il mbsiUc* In the Invc^K order, tl prdinjidlj AcownpAitln the ^^l^ii* 
of oi^Mik diirvti of Ihe brain, apoplexy, unrEnU. m^vioLriliat iltrpnrr- 
tlioo ftnd nxniagElfa. It nwy also tic ohM-rvnl in rlh^M-lm an'.l varicni!! 
aasle iafectun** rkL u ceirbny-spinaJ fevrr, KpticamiA. typhoid. 
pneuroMiXA and lh« tmiltiipniaU- In novmil chilflrm It moy occur 
duHnc lUtTit hi the adult snUtnag fium thnrnk discvic of wmc of the 
tjpt« mentiacked il may b« pnwnt both waking an^l sJcepinf^ for ton^ 
periods Ar<l h a isat repcaie<l by fliplcr M^a m atTtrc and cnub1c*nmc- 
M to mterfrn- with cattn^ [( is uauatly a firocunor of death mtct- 
tMan- TiaubrS thmrf of lowpmi imtiiliiiity 'jF thtr res^itniloTy 
(cntfc ff combined wilh the foilgue hyfnthcaU of Rownbach wcnild 
arttt^tialclj cover tbc phtnomcnon. 

lacrcsMd Fnqveacy. — Mcft tcyrt iocmara (n^iuenLy aa^lumoat 
dfvpnceaa not ftlenotk m ty^ 

Hictough. — Thla luddftt i^MBitiwIJc roniraL-rf^in of ihi* dinphngm 
oNea Icttponrx and DCgUpble may bcoomt one of ihr mofi acrk^ud 
<0«plci6ona of acaie or dironic dispaar. Tb? lUnckiL oThinanly 
shan. maybe pnilonfcd fur datnoc ncek.iand rapjdiy cAfiivuhl ihriwtiriit, 
U may be due (a) to orgaojc or fciTictional ducaae ^^t the ntrv<iij» :q)^Dni, 
(b) of tho alnlinniiial «x>'*>- (i) coiuititulioiial duwaMa. (dj mbLrUuiicouii 
aima such aa were acutf Mtftctioni^, Eh« typhoid slate, alcohi?lkm» 
pnramoaJa. palmonary i^ngrmtr. chjotlc henrt dismse. prvgnancy* 
cic. fl «wjld be ludcea h>>give in ddnil ihc varioiu conditions whb 
whkh tl it aaudaied m It may tncyr in mty exhtiutiing Hiuqu. acutt 
m t^r^mU. Occurring vrilh fnflamnuition ol the dlaphrajciii whclhcr 
rroni th* puhsoQtiy or paritoncd side it coruutuTea an a^niaing 

SHOCK AND COLLAPS£.— rAtfj>>H^l<?Mjan— l<^<redlcmpcra 
miv, ci^M TTi Kurfjicr- vcnk thrudy fiilir. greul pmilraiion. pAlEnr, flip- 
pDCtvUc <DiEncnaBce or an exprcasioa of Rfnt arudety, combined Uhiih 
SHtt Of dlsttry mcneal t\t»nttm- Prrvjouaty existing pain and disirv^t 
arc ofbcn pcslly relieved nod ijccMionalEy nuAntciiin^ied by botii 
padceit ud plijivicvn. Li k oDcnaKmly iModattd in medicine with 







uEDirAf. uu&yufiu. 


thOftC intra -AbdiiniiniLl dubcuc* vbidi have « tuigical iiijc. for^iompW. 
perfonttDjj; aii^rniTiirtl ypturU^ar duodcnaJ ukrr, hq^llc Alncn* 
ftod oculc licmurrha^c or iup[iuracivc pMnavalJiift^ Aiminjchl oilier 
cmusa tTt ctnngulalnl hernia, Mverr uHftrniv jmrliTiibirly Uuit* 
Mlendnf by cnuliing vioknoc, And, in ib luMf ckgno. cvca in the 
tcrorr naitt tnlccUon*. imal Hn^ hepatic Do3lc; and in ooaditkiiu like 
' an|Ei^4 |ri^iUirU ahMHtitlnl wi1^ rj^lremr. ]me]i, Iu (yntirioms tfcoiiU 
bo dcarlT borne in min4 an>l itPi mnior form Hirtmid/ »ukism1i a doik- 
^miu an'T {irolably irnninjil Li»u|>lji'alti)n of Himr ni^iuii; &ilnncnt, 

Ccaceakd Hcmorrbige. -An ^UnshY open bfcnarrhApc afaaoU 
InT&hnhlr ftncftth- ^armt and exdir« in rkiim; inicmnl inH toncMlnl 
Iiroivrrlinier ijfooiU >jnip1nnu of thock mii cvlUjnc tofielhcr viib n 
LTfl^n LuriiiuA miJuinicw and utltfmjnic4 yiuninjit lUium &nd ^r 
Eiiuit^cr In uny olbc of aliixk ui t-ullapsc tbv rtoob tbuukl Ik lucf iiUy 
cXAmmcd for blood «n<l in nurrrcrl vnjmra the |HiMibibty <4 vctapiV 
ptlailnn omnol be Ignonnl The Hcnr miinl of the »flirr aa^ge miy 
yield to dehrfum «nd ocx^joionally thcrt u« oonvubDon^^ 

^ewpfr^ tff Ctmct^kd Hmorrkatt, -AmooflX ihc nuvi conuncc oic 
brmmhona. A4)tiiH»tn^ rupluiv. tfumknul uIut, tfv^'">*l> K'^^^i-' 
ukcr, ectfipjc Kr^t&tion or \ivh\<. hfrnilvodc Irim any cauftr, Imiraai 
■s^m, ihr hi'mtirrhjij^ir llAihnaii and Trr>' nirr!) in iwlmonftij Itibcr- 
^luM* B UfKi" I>cnii>rfh4jcic v%X*> 4n old cavily may for a lime be con- 


Regional DivbioDti. — Tht tini^idu'- /.u^/-v;<t ur A»u;k'<if lx>nbhariiij;r 
triiirkiriK \\xc junction of Itc manubtiiim vrilh The gbr1ii>1xu uf the 
tirmmn. inrlk^n rhf lovrr Ivonlrr of thr imrl^trirrb, Thr IjIfnrmriAn rif 
ibr (i^tbcA, ilic iv/»tt|i>n of the 1>:irdcr!i <ii the riKht an^I kft lun^f. and 
ni#nipfir I ihc MviiiH KLi, /A'' "J/J^ EndicnlH. oMinanly, ihr fimiili jnicT' 
I space but is xubjca t» mafLcd varialKin \\\ |KiAi|jon^ partEcularly In ihc 
fcmalcH Th« bw«r bnrdcr t>i tbr ^^U'r^fi* majf>r Ktioidd rorrra^wnd 
In ihr iipjifr li^^tW iif Lb« MJilb iib. atir^ |iiiMrrinr1i. I^it' ufijrr pottion 
of tkf tf4ftilit '^^mr^\t^^Df^t lo ihc v<onil rib; it:; inlL-rior tinplr lo Thr wv 
tnih *>T ^U Imcnjiarr; diP root of iti <|iiTw ir» ibc ihinl rili and ibr 
ligTiL iulcr-V^r Rmirc. o itj^lon nh>«« tnipoftonl tn cnnTicclion whU 
iDi^un by Ihr ibb4jivl« liadlbaft. 'i'hfl ro ^ra rr^rmal divTjdont 






■ f-v Uimu|iiydi «v« ^ 156- lUmUrMob pi. sjo. Kitiiluia p it>« 



mi arflllBw Hm* jnnwwy W wbol or wrilloi doei^Mloft. irt' 
detitr iliaM Bf 4i> pint*. 

Tl» Thoracic VUc*r«.— Tbc heart «ilfc h* ttiril itskK thr luap 
unil Ukcir pviniKiy bronchi, tn toKAirnf^ vitccn. the liver, vfinft jiDit 

. » ' d » , 

I ,...r %ijrl>'^ 

I. . ■ tl>tlriF 


-■Ub^a* rM linn. 

r*«f ■fitHnn ilul. I -- - <^<L 

kidticr»> nnd evo) a put of Uw itamach *a tkfitttfd vikchl Ihaugli 

Tht Lnac'-^'^'V ^N^ ocrapy nearly aU the upper chat, ihc-ii 
Afie^ cOcndipg to ihr Levti of thr «rvr-nih cvtv(c&1 «p^ti« Wb^ihA vA 





an bch lo an inch and a half abent ifcr darkle in fitini. 1'hc r%lit b 
filially higher than iht ttfl. and their usa^taiK* may be didtcd over 
flir *hofc o( the luprHdiHicular and «jpKi*c*pular nghxit. Thrir 
antcrbi boTdcr»ittcvl at ibcAcinal antic and, in ainUcL pai^ rcrtkaOr 
dawnfranl loUwIoveloE the fourth csitiU^; thcnco the kfl lung pOMct 
zial ' outward, tvrmitig x\te \f!\ liortkr uf ihr sapCTridal ardiac n^nu and the- 
■rvL li^t contiantfl downwarl to the slxlh nrtiUjfc and in iht ctiiddavicular 

t line both lover border* are rrpreirnieil by ihAi riK In mM-axilta 

I ther «^ut ihc ciiEhlh; In ihe aicapulaf line, [he nlnlh. and ocu the spm« 

I Riach the bvct of the tenth spiooua piroceva, I'nm the mid^Ja^'Kwiar 

I important arri Jnoluding the U\*t. apleen. Btr>mach nod 

I kidney's. Thf Ihfr !yi[)g beneath aiirl nrkpiing hidf 

^^K to the domelike surface of the dUphm^^, nsci into 
^^V the Ihofflt til A rru^h iprnter deRTee Ihsr k ihown 

Tcodily by pcrcufflnn. but ahxiiytt livrr tluinfu he- 
fLoa at Um lower bortler of the lun;; »nd rxtenda 
doVQwaid to the cuatal [naipn.* 
Traube's Sami-luiuT Space.— I'tiii is Enelodcd 

btlwrm the [ower border of the left Kmgn the i^eeru 

the inferior eoilaJ oiarKin. and the left lobe ol the 

livcT. and U nonnally hj-pern^wnaTit bfvaufte ni the 

undcilyitii; fttutnath. l^kr fiUurrr extend much Icpwer :i—r*nJih*( 

thon trie Iudj; nnnrgifiH ttin^ tvro intbes tntenor in ^^n'^m *r »^^iri 

.1 ., , , , . 4ni;> If vEilf 

the mnrnmtuy Imc. rrachin^^ i Tniuimvim nl foilf itf-nMr ^^uipmi 

I bdKs in mid uillk. and one and one ludf inchea in rc';VJ;r'L.*Jur3 
the teapular ILne, It ivill rhun be rearliTy Aeer ih«i ■^^''''"^ 
any tmcJl ffftai*m ej fiuid tnW tht U)! fittrat sac ictJ/. 1/ free, produu im 
area a} mavi^)U or tki^timg duimtj itt Trjut<r'i spar^t amd ttuil any 
ittcraue lA the sisr of She kjt iotc cj tkt liver er fff Ikt ipkea w^ ft- 

I dttce its hifrjl dimtnaicnt. 

The LobcftofthaLnnf.— A Hne drawn fFom the wvi^nd clonal vpdne 
.under ihe armpit lo the middle of ihc uath eoaul caniU^* djvidn 

II [ Itinjjf rntn Us iipiurr and lower foT>ea On the right tide x ceoondUnv 
f drawiL ftuin the nu'ddle of the fi»t line to the fiiuith rhanilro^flrmaJ 
Hftiita* lo I iDint marki the upper boundary of the Tnlddlc Lobe, Tkf }r<mt ef fU 

ythtsh Atrt)tm»Aargriy rtprn^aiA ikt ttppfr. ihr b*uk Uie tt/wft ithe. Ihc 
ipex bd&|r*cctsilblcbnti] AAtenorly and {»«tcnoHy. and ihc middle lobe 
t« rhe right nocvpying a portion of Ihe ajdUa and the arii«rMr atirface^ 
* for a docrtpilaa of the bepaAlc and «plefllr afcaa an p. 3*5. 



■ lurnrvi 



prrsmti^^U), X to^.ai ibclnclnf l^r irpfjrrlinTiliTof ]hrUtin1c<alsl 
avtiUccVu (b)' A ngkt fdnicr, curririg imta tht ri|;li( base JownwAni ' 
to the aixtli dhondiD-slef^ftl srticulaUon ^nd attiinmg \ <lHTaiK-r r>f ottt I 
or oac and tmc'haU kctioi fmni ihc nj^l »l«n)iil bonier under the i 
fourth canilAiEe. fc). 4 /^/f bonUr. whirh curva outward nTmoct lo 
ihr aabkUTkuUr line. And lh^'\^ iitw^rrl lu a |joEtil »av Inch wkhhi iIijli ' 
line in Ihe filUi inETtHpaof, <d) .f Jrni'iT frfirjA- ronn^riinK i])o lowfr 
cxtmnEtln of fhr Irnm nrjirrwnting (he riglnv aril IrTi honkra 

The Aorto*— l-'mm tL* ba*e, (he aorta snecp* upward ami lo th* b™„j 
right, its n^M botrdcr pro^^cuoji ilightly b^y(in<j ihp itcmal margin. 
ti puiiac WkvanI and ivwinl Uic Idl in xkIi a trkantier oi /o Jrdi^ vinrnt 


HobUtty of tbt Ue«rt— Siupoidci! within the pcn'cardul mc by ibc 
grrat vesarU 41 la hiw. Mr hioft h rtunoAf/ ltjU inf/r^Aifj? diipUtfutU 
uodcf omiun pUhciiyqpt <i>rLilitK)n«- A'tUnnrly >/ ^rctm/i tif nf^i AnrrTlw 
dUim6trt. iM^y tht h/W vm»iele, Ikt Itfl bring m/nn^iy rtprti<nUti 

of tbt Vft long l<a^n«4 portion of xht right i-enLricie unoj\-rrt'l »nd in 
vtidi ftnf pniifrnhf tn ihc chr«[ ju tn ylrlil dnrirlcd ficrLTiiulnrt chL[nr« 

frwa ihf /ourth (a Iht tivift thmdfv^iUfWd ^tiUidaHm nmd ill ^pa: at \ 
or jnU milkin Ike tfitx^^rat ikr friv^U being fomf^ck4 kj 'm^ ttwtttti^ 
UitH p^nu <St«bg, 14.) 
AitA of RebtATc Dulnvsft. — Ii it to diftnik Id occimu^^ wv&cvc 


(ill f**. 

MKmrAt niAANVI*^ 







the aannftl faevt thtt nuAv modem diajcn^^oti^uiis u>e nra ftrbiBvy 

uid nwuuR bny cli&nKc ia ihr U»un<Wio oi the ctivclopini; tun|> or 
in ihv sm i>f the htan. (S«« lig. t^,) 

ApOJC-bttat.—^Tbi: uptX'lKai or visible ind palfialile liwt ini|jub« h 
QormAllif founil in the tifth intcripaoe. on inch within the audclmkulAr 

The Hettft VaIvci-- The iniif«l, tniu«iiid. aortic anrl pulsioouj 
vitlvrK am itnnti mui'illy lifflinl uitlitn fo witM % fpaOf thaf A Ui;^ 
MctbuaiAJjx; brll will iKaitv cuvtr than a.11, bul /^rV rsji^iM pvM^m is 4i 

The Ctipkal VbIvuIat Anns.— The pnimk irtilmrilf fitnl Jo* 
ftiHcuTuition 4rT- u), Ttic 'nt>>)J jri-o whii'h (^^rre^fiofLdt 1^ ihc hc&rt 
AprX- (h). 1'hc rnrbi^'f tiTfrt onrraptmcTing ii> ihr Inwtr hall of Ihc 
sEcmum, Uy Tht ^vimvn^ry atr^ cijrrt^pcudiQg Lq the wcoml tcfl 
InifrDMtsI «pace M kU tXtmal vAge. {A). The arrfic arm convipood- 
, ing to ihc accunil Ti|;hc inlcr((k.>A4] s|ia£C iL rijchl eiSfc of Alemum 


The didtation vrd mterpreiotinn ol the phyticd ugnt ol di»n*e 
tlc|icnd u|«n inV [nspftliiyu. <bl. Falpalifin. fi't. rmrimion. fd). 
/lMjf4iJiaiiffii, Ic). . I uf ^kJfdicry ^^nrvftnTn^ (F)< h'tta^ftitpy da4 X Utty 
pht/t^Krafihy* T« a Irw deRitv <ine inrokn cerlniTi auiilinry mtihod« 
deiKTitlinj; upon »p(d&l pnx^durts or qM^ialtr <lcvucd lantrumcnt^ 

Pnnqvislies of Good Work-— Kvrr^ siuilcnc uid ]>h}<Aician »hetiTd 
thoroughlf fAmillohxe hlmiclf u!th tlit ililkiIi nr^ttxlnl j>>iyvi^ tiffv* 
at And/lib «nd the naiure uid «Tleni <>l indivi'InHl vui;iiii>n, 

Thorou2hiie»«.-'Su|]rif^|]rLl I'laniiniilJonMirK' fata) li j rLimtiUum ;md 
j»r™ijjp?. Truf fttnunny ftf limf J^^fnrfj upon a efprrrtJ and tyTtoMtic 
tn-hmqvt imtt mfthaii ^vkk pm/piinn and fffiffmArijJl.nt. As nnc 
jToids jLikJt>j;ihc umc qucnian ivfce iuihr:>u]d he lr> in ^i ihc pb^'aital 
ligni firmly in hii mrmory, and ihf v^ll tmined man ttill ni.ikr a com- 
plete Ani9 IhniiiJEh i-kAniirmtiiiu ind dmvh hb cvii(lii»uiia. whilt the 
ScwiCdcred bltindcrtr it «tili tkimining Ihi- aurfiee. 

EucDtiAlA. -A knuAlrMlge ot tnpogmphira-njiiomyiindofibcphyti- 
olop and|iathoIi>j^ofthcatru(HifciinfirrcnniinMiiinjA C'*'"! Icciinique 
and a pnetised h&nd; gcNnd eVT'tipht and hearinjc n^iiti W riiirrlxTi^l 

* Mcrt«UTalJciiL U aIju tiwd bur a vf iQcnporitivrilr alfglii lulae lOd 
ifir^metfy in4 ^afh^tfriicffv *rc of fftiW use- 

tntOLAiaat ur hil riiojiALic vi^rKiiA. 


wllh aa u<«nl« tnftuiMfEr <■( ihc phpica.1 ligiu of ktalth 4»4 Am^r. 
Atty Mu vibv c^mbmci dUixfttct tnih etiUnatj mifUigmct mn l/n:amt 

Tlw Prapantloo of ihe Pntient.—Thr fhrtt virrn/r shnufrl hf 
pfopofy cxpiM^ »nij flooded nith a tiKht hivinK ila source brlimd the 
plijric&ia whA i» ibM il'li-i in hU ^r^rvh Inr [ihjwcal iiffrit and hu 
ttud; of phpM^uiuj u»l ihc play «f ft patitTic'* c^nioii^insi ba 
bttng in afaackv. he cut at^tl bv(rat,tag lurpriv, diupjiaintnieni ar 
dlMiuy Smkrtd. hit^. tluafmiruit, intt^wjicmrftt itnd caim aft tkf 
mtiy ctffraittu dUtnttM* in fhr 0^<', imrif f, or ^)>> fiu'in. t'iir. arfunxf- 
9tfnl -fl ihr dtdhimg artwx lie^pmrl wimi-wl\!ii »p»n thi' >4i*x nf ihr i^- 
ticiU- Id doilmj; ■^'th vomcQ or r<"'^ JC^''^ ^t ^ uiuallv fniuiblc lo 
OQuducl > ttliliBaory finiriiiijktion villi lomr ihfn. tnft giirmi'iK rover- 
in^ ibc lovcf pontLn] tif ihif diuL Iti lIic m^r ^1 lUould ulhvd\^ be 
unaivntd, wid w m the fenule if tui\ real neresuiy eiittt. or if 
by pourt CJtpeHtirr Hinii? dtntbx miiy be rrsinlvr^l * CrrSttiiUy tta 

<9tpitdiiirm m Imtg <tpiffi '» hi*4rt murmurH l>riikg iimulutrd by the 
cnuklinic Mid rubAiinj ttf *.u[irnnificiiHd utaknAJ < ir tUclj cunduaiun Kjhi 

Aciitnilfi of PsUmiI and Pbyskiui.- WteitHi in m tail »r l>rc!. & 
pftlxw »hjiuM. Kbcnt\iT ^>hHtbl& be ic wi vuy. UAOon»iniJncd |iv«iii'>nr 
ibr lifiiniH rel4Keil aad ihr U;nulcti*n M|IUxt. In iht^ rxaminnl'tn oi 
l\\t liiDC x\Aas cjpeciftlly, both Uce and chm should bi' iquarcly icr 
the friwii ind Iho he»d fiitt. oihenviw de^qiiit^ diPlerpi5c« in pcr-j 
LtmiDn miy icuill (rvni raiiMulu o^iiirActiiKx Tht plivMuin ImiudlH 
jhiMibl ftdopf Ibo VMitti and mfisi uncimslraincd pcitiiion poulble 
r-r Uiih prrcuvwn ajzd &uH.ylr«iiun, 

Chuice* oi P<»it)«dl4lliriac£xiiina£Uitioa. Il'/rrnn'^ ^.sdi^Mf 
pafUnti tkatiU ^ ^xumMiud bath in Ihf rtttftnbrm and rrcd potU^fe. 
Ln^uA' ol Ibc ixieulkr UcluWor of cerloJn ^Lrdicic cnunnun referred 
tfi Eunhrr oA, 

OlSPECTlOIf, — ,'l jfi'infr iwtr-tfii iA^ (fivjfTjJ riiHf<»jif , rtH^fj'fion nrul 

9} txfaiuiait. SMt fmtntt fif uan. tbin mifitttittt lit ahatirmisl gnr^ks. 

*Swcli b Ibe unBdfftCc pJ«(«tl Ln jumJcwjoBol bunor bnd <lc«n ntiti^Ictl- 
IKU tlui Ifae cv*dlne*t b^ eomplr wiih hticb rtf^iicau u UAiudly a nKuiurv- 
ol th* ■ mmn't r ti»<i nM» an*! rtil mi>^Ty. 



01 wivnpn. 

at i^tn* 

A rAA 



live '«]«, 





» SfUnfll CDrtBlur*,'-!^!** i nodi 
4cd » 

oftiurmitf fWulficHii. 

GeneralFonnoltlieCbwt. -AU»la|« iranneU^ aua«iual liccmvic 
of t]j({fii Ufmi] om^tUTT tit ih^ tpanr, n^t or left tutodedntt*. or lit* 

liivijU und ncglf^blc^ A tti^ki watr 
in^ 11/ muuU in jA« rfpnvi 0/ ikr Umg 

>. tic or sooTlo-kyphotic dcfennliio nccil 
tjo ecieod^d <U«oi*tk)a Uil the ttiulfM 
wlw liu MCB mvkviUr <lr^iniiH prr- 
WM mnt to tmtopty will rvaliK iJie 
liji[>i.-r(jj]iir in lUdgimcdt a^d pnf- 
nciMA of the ditqilacfmmt And ocnrd- 
Ut% of rllal vtruaumi- Unitaitr^i dutnges nujr be due lovtcarionft 
emjjh^rscnu. Uim'tn. clTi»ktn& *^t conx?niUl 01 juvcallc licftri iliacwc. 
VnUattrr;l thrinHng Jrvticirc& plcarUk adhcAUinf. drrhoA&s, ooQipse 

ncbitic dH3l. lra>iMer^J> cunsiririeil 
diMt. aiiTtncd dtat* p^coo breast. 
"trirhifH>m«" (futtod farfUl)- 

Emphrieauu— 11 ^houM Lc iL> 
llnitlj liiidcmood lh*t lb* bftTTfl 
ilupctl diml uf cuiphjMnna is orAi- 
oaiily nunilcsl only wbn the con 
pcnsioiy ctjni: uF ihr »i)iaal colimn 
b slTftlf^cftcil out by pladng iht- 
potitQT In A doTttl posEtioo, Such 1 
diaX o{\xn ap^xan fUllrard aalcriorl - 
xhen the |>JiikftL i» fTRl, 1b« ^ouldrn 
brinK nninilcil luitl the potloit ali^llr 
■loopc^L The tMtff PMHiftf is Ahtfi «f 
^fVmniwiif ^imvirf Jru^>aJ»m, the tpl^ 
S^£knc oAKic bcinjc bro^d, the neck 

Kfaon tho atom Ruiiotd muAd«« prtiRnlneni, iho rib* umiiuaDy rigM a&d 
the mavcmcmt nii»c a vertical lifti^i^ ih^a « tnie upuuion, 

no *'AlJV''Ch««l.-Th>».Blw called the "pterygoid". -'pflfAlytic" 
or ''(Bbthhiod chat/' liua small uitcfliJpoileiitfdi>metcr. lon^vnikaJ 

rit- *»---i- ?CDfiiut Ckffr *. 

Il«fai bmaL-^ |LKt<l>,l 

brofttt iiMcnipvciei and ruirow cpffEoctTfc txi0e. The neck 
\% lung ax^l tienffcr uid the pc\rjcaJnfc »c«;jiila^ ^ive it xht ^trxvUti 
bAdfcJ tunc It doc* cot isovc a iubcfCulri«U. but mcnlr J>£f«^ 

Vfirioufl Deformities.— The tnchilk 
(htfil i« brsl miMnpiJncd by tbc pigeoA 
b(Ta»i uid ihc uunAvcrwIy cimstrldtd 
ifaofax indicfttcs ibc co-inddcncft of clcfi- 
tknt nLiirlLkoi and aornt chfonic obotnic- 
lioD to bfOAlfaiDjc in diiirihooil. uni^ 
nun-phftrTTifjnd iflowidi. Th« luw trf 
ntriKtion U the line ol clU|ihrA|eDlAtIc 
«ttAchniFfi1 inr!icilin;c iu doM tfoUllon to 
impedcct cfiat ci[MruluEt. Atmdingof 
Ihe ribft Ml Ihc cbondro^oiUJ aitJcuIatioiu 
is wd! kn<wn iw t>ip "rlcMy romry". 

"Trichtcrbnist" (runml brr^ja^ bof 

litdr imporTjjice in di«Kiio«ia, lliovi^ an 
inlrrruinic and >|:ikuaK (jhrncmraan. Il 

I4 wprcnTind by a jijtootc dttptming Jrjm nb^nt d^ a m v tr4 uid coer^ 

ponding lo ibc tmnid |vrlJun uf Uk: Mrnttim, ihi? oisLfnnTi ofioi 

poifUuig rfHTJlj' forwd. Unally oonjccnsljil, ji may be ocajpation*] 

in rho» vhn En e^rly Itfr bivr prrformMl wort oettfl^lfns contin' 

U0U9 ptTWue OTTT the rtgi'on. The 

"lAtfTttv m hsk^u*' obicrvrd in crruim 

CUD «f qrTtACO-nyTlU »I)CW> ft deci> (ct- 

diu gmn« in tlic cb«al aotoMiTly. 
Localiu4 duukfci In Oatliac. - 

Tbeae are o[ omcfc mart sijnkilicaiicr thin 

QSicfml ddonnitm and ciuktHl nrrmr' 

ikm of ooe 1^ or localucd rdta^un In 

Any afn nc^y iJvrmjift mcojnt an cJd 

pUmtf* ttiruid pbtlibi*. pout tubi:ivu- 

loiv or ■3J«iy. 
Apex Retniction.^^SyinineUicjil ir- 

biciM of the Apices due to naml or 

lottdtUr rfuilnirtioQ it cnannon. n^gil)]!- in tbr ^imce of phyilca) 

sifiil and ciufi tn adtJu may pcvmptiy disappear after opcntiou. 

Uititakrai inlndtWrabr or tuprucnpaUr ht^llt^aing «uggr«» ciiftirig 

or pvt dbrwe of tbc bin^ oc plcuiu. 

-J -i «.. 

lVr«tiTtt IdV>p, 

Karhiiic , 

Anil cun- 1 



wivtcjx Du«Hoen. 


An thmr- 







< ^u** 


Cbc&l Hcuuremcnta. — IV life ItautMOcc fcquiirBBcnu la tciftfd Da * 

th»l tlip dTTumfrri-rxv uf thtchcsi >l ibr Ir^tlitf ilirjirvtpk» ahillcqaal 
Oiw-bALf the hd^l at UicmdirJdu&lin uichra> and that the dtficrcnce W- 
iveea lull inipiraiioa and fom^l ripinikin thall not be ksa ihcui > imthet. 
At aicfX oi long upuJly this lut nquircnKni is iA abaiiTdilyH fiif ont 
«bi> ouinot expand under proper insinictkifi one-tenth bis dicsi drcum 
frrenct \n Inchn cvi bvdiy be txtoMtml oonnaL In niCAhurfngd^ml 
ccponvon. one tfaould dmw the tap* very fioMTy ai ihp Wd of ihc 
nippk. «|)r<]a]l/ tn f:i1 luilividiuls. /4MOTiiJnaf mAUHiviiviillr abMitd 
shav the muEEmum SLJth v>iUi JifMy drawn upc f^nd should nevct 
cxcord that of the chni in fnll mipirDlin/i as ttAliiticfl thaw ihjU >ud) 
buvr-«]ii<lirwi7Ll iicnvjiu fjmUh a licnty cil:1/ iLiuctaliiy,* JfiirM 

adhe.'nims uf «^jrM>f ttfjortnity. jr. huijfi/i): rauin^ Ay pUumi fftanjmt 
and wtt' ^riTii^. 

ClutC Hov^mems.— Normd] Nrijittiinj^ iHE>f Imci irffn. Ct) ^oiio/, 
Cl). Moninai. Thr nrat prrdomhatcs in corKt^wrj^rinje vi'dtncn- 
tbt Mcond in nwn, T'luif n] itwHOt it l^'f^y iH/vriuf-fMlaT Aof «/ 
IBM infrriar^mUit aad abd^rtniniU I'mbinrd. In iiuniial biraibicic, tht 
ratio of rHpiiM[ii>n ir» j>uIk- ratv u almut u 1-4. tia nic U in die ncvbom 
40-45.^1 the agpof Ai« ji-yG. Ii ihouid l« iymm^irirAl,«My and<|uk1. 
and ilic tvri} udc* of the chfil should taovc eqm^ly and lyrAniTiMailjr 
TA« rapirafims is ^/^ cduiilAf hy vaiching Ihe riw and laU of |h« 
«p<i;7ialriunit coincident nith t]>c SiCiioa uf the diapAmfpu. or the tippc/ 
diecL (if irum^rn. If on« o«|eQ«njly COUJIU I ho pubr^ keqiinfc 
llie rye on ilit jitTi|jcr nn.'ii. iTeiUitr di>iliu]|;i iiur Lictl covering pre- 
vents ihc uw of this meihod nor do« the paiitnt's >d£d>n«dimsneM 
Inirdert- (See also Djipntca pLj*.) 

LittCD*ft DlAphnsm Pheoonicnoti.— Thiaiiftpihani^ntjAmiov vl 
ini^tr^lor^ rhiihm paMinjc cLtwnward fixnn the anitro-laural aipecl 
of The aiith lib and wiiahmK juaL nboirc the ccatdl mAT^n^ U ccErrr< 
apunda to ihv mjctiofi cverttd upon the incrrcoatal apchna by the Bepnm 
lion or "|ic«lirig trf!" of the pleimd fohl tnintiikiu wiib the dcsreDt oJ 
the diaphiuf^ ocd inferior border r>f ihc hiti^. and its movement nht'uld 
nir\f^ ttfim i ify 4 inrha In the nnmkn] rhrst. Ta tikit At tign. ihf* 
paiicia *hi>ald be (Jaced u))on itc back {atini- the lijcht. Uw »!iL)u1dc]» 

'Oddly enmigLL, othietti atid ivnt^mfihti u«]l:i1Ij •^lim tl»- hi}r]ir»t 
dgurek In thcAi dpaiuiun. iKt^fiw Luih hate tm^n oprriiily iiiMrudr^ 
Olid |>ir Unci i^Mluc dect» bmihiuf as a thmpetuic mcvduir- 

IVfXAflEA or fWC TIKUiAaO VbtrUA— P«t^4T10ar. 

tdiiciilul dcvAlcd TV obdcrrcr dhouM stand with bb bock 
ti> the U|;bt. Ave or kIt tvtt away oppraric ihr patimi'i Icn^fs. The 
ti|^l flhottU cnnc frum one wIntUfw only* Arti he not loo intent- tl | 
it rewlPjr kcb ■> all nisreul chccli nol hcax-lly <^trUid by int. but u | 

*/ A« iwvr takf t* Jumtva Mtvpymg tkt t*fjYr fA/ti o«rf f "^'y «*!>'<« - 
' Mfd in MMjf it taeipitnf ^r atfiuN/nf lubffaditsis an'i nnphysontt. | 
Os tbc oUier famd, Mroors or flui<l bcbw the <liaphrA^^ may n<it , 
vMirHy Ciblit«fBM il. ailiJ u ft iWcrcniial fncmr m ihcftiagnuJA oi 
tabpbnnic absccv it bu not bomc iiul ita early promUc. 

FLUOROSCOPIC IIETU0U6.-A* iPw dctoiiding diaphragnurlc 
fthukn* jfrunitrly dnrrmirin tlic iditive ivtge of cncunicin of liii- 
lower border of the Utijc Mis ii I'ltr ^; IJu Wst iwM^ f^ ddtcti^f; 

tl ^^^^^^^^^^^^^ incr^i^l /vljmrHinnr, j tnutU fata ej im^i- 

I I |>hy»jcian »li»uKI finii1r;inxc bidiiclf v^h 

I ' The ntn^' in normtJ bruLlhin^ 

^k^H^^VH^^^ PalpNtiDD fis ^pfUtd ta putnumary 
^^^^^^^^^^K^^t Jj<f*v Aj* rhiffiy kt do vAih Ik* 'UieciiBn\ 
^7 rt/ frtmiius puitatiim aad iun/f rxptjniit>n,\ 

( ikl o/ii' lirfrrMi'M'J Ihr form <i»n>u(n*f<, 

L f-tlfwi. mofti/ilw iitbl tr'tiiiii'^rift\ a] m<trtn4 

■tn».n;;::s^i'V^«v ^^^ -*/ ^^Tft-r-*' *w', '*/ t..^/i^ of ^^ 
»» itA^ttiVrti*. lOLNui. jHtarau.thi pTrsmc£oriibuiU€oj mMMktft 
ami ffte ^ucj/ii_v dW ttMtin^y af JAf s^, 
lteqil]mtoi7 lfoveiiMiit>,-'Iii thUmnnrrtJor), plfAikm o^nAnnv 
oontcti tmd tia^ht* Ihc rc«ull of insr^ttlJciiT. Es^pAnabi; uf ihr iwu 
tidn »liould bt utiikirm. cwrKititnt in<l cquil in deep brvftthi;i|^ Jin<1 
ow iio»c»:— h). dmeriUty inaraud jt dimaitlud tinnfmrai. (i). 
UmtiaifnUy ntardcd irapintloti ( iTupimtnry Uj^nic). [j|. VmUieriiily 
rtUrM apiraiiDh (rTpimirjr^- InpjnnK], Thf hcindfi arr plsrcd (nlrly 
upon ihc chett. palm iljwn iLnd the i>Uicnr «Et» turirijt t\w U^Ni while 
Ihr phffirfAn I'lw* thr <hr4 tar jTi^nit Ally tMni hrhlnrl Two prndlt. 
kKtlbjikla, ur outclica. |:^actij bctf^mi llic rin|p:ra Leiicr ^w Uic cxtmt 
of vtonvracbl. For Uir i^rp«r kiw il i* util (o piftce the lihumbi in Uiv 
Mfwufaiviculaj sfoa: vxl the finfcra in ibc infmdaTJculu rcxiun. 

aii'l lU op- 










p*reDQ« cannot bmthr of ixva^ to ordrr. aoiM <la not know biv 
to eipaod tbci' lungs. UMt^frml dtjecU i»J af*»s»m lodkUB » 
cdpfifed ]uu^. be Ihc oliuc wb4l it mttj. De/Ut^^l uff^-4k§st $Xp9m- 

goel thsirutHtm, ftf eoHtU hrtaJkimg it At ntirmti jemimvtt tfft. 
Su^rrior fartttl hfmlMtt^ in mm skauitt imd tiu lo tx^miim tkf 
Itmg hasKi anJ *t^fK». Any lack ot ibc dotidbI ins'timUtiy fuluoi 
in the tplKJutriurn- unilatf ral or biljTtnL Micb u ii nm m dMflw^t' 
motit paraiysis and ^ifi/W ultiimiuul affaSwH* shmikl be nottd, Thr 
bfvftLhiiif^ oi A ETAA wiio hu A famftil gtifWih ^l d «iwv«Utf «rMh 
fkngmalk dryrut it Ukrly [n Ik' jiWhi* And of ihc ffittiniiK tjpr. 
In ihc detection of tfndtr aim. ihi; expTCMion o( the i^ct ii ihc lofia] 
guide- FUuwiU JrUHsm 6$iA foarte t^t moy hf paipohU. 

Vocal Fremitun.—Vwal (nmiiiu or ibc \ibr»iJon d lite dicM ^suflctl 
hy the produciiop of MUiidt M the gbttis i« U*t detailed bj tjautu 
npOTuly pkcInjE t^ ulntr jmrfitcoi u4 both bunds uiion tlic cfanl U 
ccmupondinf; op|K«iu- poinit^ Tltf patent h then AAbod to cnuftdaic 
d(*4iHy ^h* wrjpit "nirir," nr "niTirly-nitir,'* thr mullant vibtmlion of 
the dic)l under ihc haadi luring noted and UiaI of <Mie side LturJulv 
<!om[>Ared wilb the oihcr, it tt a \iscful procedun nltemaicly to nbt 
4Uid bwcT lilt |Hi]t>ftLuiM luujilb. ihus TcuileHntt ihc watiut m frfntitui 
moTr durtind. or a|>W>' '^'^ i^kcnc hand, finit to one aide and then lo 
ihr uthrr Thtrt m rtorrwi^y j prrnpUhlr diJltTmc4 ftetnven ikt 
right 4fU left fUf. thai oj Iht rigM Uing: iti< stnmftr. A m^tU 
tUgrrtntf is 4 mpki4yus ngu. nfuiialiy it tkn frtmiUts of tkt Uft 
c^tutdi thai (V th< fitki ifdc. and rvfn an cgrwJify i/J jrrmitus jJrmU 
suggfsi a *pf<i'>l fxmamcHen of iV tffi aptx. Vocal fivmilw oaniatroA 
to the Uws ot a»und cunductunL- In geiienJ it falbvn thcrelnrr-i 
That if hrm^hMi nmmwtkalion mtlj. Mr /*N«i^ and deeper ikt owr- 
lihf gft^ttr it ikt t^tmitm. 2. rke d^nitr iht tcndutimg makH^, 
Ike frutfr l&e f^mktu, e,f(„ cmtMUikd lung ykM* incfmusd jrcmUtu 
provided rAdi it is in ttmiaa viib> » turr^andt a paUm bromckm. 
3. Tht Innummitm of the zvuntt Iktotifh a lube a rtd inSa tm air tJumbm 
t9tis*t fww^TOliiM *j"rf ffinfitftfmfnt ef ikf iow^vm^ and Iknt 
iiKncscs /rfndW. c-G- civhy cummunicMinK uJ:h .1 UmnrhuA i^urm 
incR«sed fremitus 4. The mwrt ttamogentous tAt ^nJutfinjc mtdimm, 
th€ grmkr it tkt MkitWly tsj vtbr^iitm [inmium]. ;, Itu interposihon 
tfj mMuKCtf vf o difj^rrnt iu'lriiwiar ytn^Iutt 6eS^ftn At €imUt€M'tc 
tody iind Ikfi paipcsin^ hand ttcli at a J*t'npfr aad tnttrtttpts the 4on- 
dutSien cj vitraiivm—^^. ahiOKi: ot fnuutus in cKicnuve pleural 

or Tm iBOftActc niaiftA— pau^afcim. 


dhuMQ. liquid or paeouK. cvr ^'minuhrd ln*mittH in piciml mdludoiu. 
Tliit nur nbu b« due in a mnuufr do a rdiucit ouoicliiiuD ai ibc lunf.^ 
The iollowiBf: pc4nb ire lo be bomc in mind.' <a). if dpi«0)r iiKfttfKrf 
ftewnitm* faimLi M ^wtu^^^irtMi dj iimf Jiiiitf cv fdvtty larmaHttK. (h). 
MarMiy iHmmvhid fnmil*^ indMks tmphjtt^tna. ptntral adJusimt, 

tKii Ik £arf!Mlea Umi the lUrniii^h mitl \mldi of Uic mu iri J ibc prcx«cc 
o< fftl bad RKUde raadity frrmitiu. -I/J'T f^af frdftl^oJ mrMM «* 

PfeM«r#» Palpation. —By b mm- thrnsilrg prraiiirirnf thf An^ 

lAps rtablorio: Arcji» mnv be caiilr «!?- 
ftnri), ami (hr m^-'thnd may hf Lur^ ax 
auniliofy Id pcrcuaiiua in oullinijitg 
cifgui^ deitdiiig ecudaic* and f^r^' 
iiTrai of in^llmtion, 

PERCU&SION,-Tb« b<HlTaiftrl>o 

■liPMTly siruck with Ihi* lips of the 

^ngcra {imm^Jitik) or a pU-AJinctn 

siidx s£ the linger on oblong piece of 

Jbd/J rustier, ijf u iduiL Eiiay W *iruck 

by lh« t^niEvr or t [■rrcittemn hammn 

'tfV-i^^Yif^ («Mirffe(to]- I( muicn Iftifc whM thr 

f fli'i) «t-»].tdift phyiidaa udau&plexuneEeEprDviidcd 

b« afUifTM ro one mt-lhc^T. 6nf /Af /ifj^fr 

tammi U hti tr Uji MM, The pcr^iujkm sUokt U U^i Trutir. u-tiA 

tlu mid^ fi^grr. iVbJ jttmld W grvtH mik a iitott vnsi as tf itnitutg a 

jimtft sIMcHq m*k am Uu pUnv. It b usck» lo j£i:l u tt^xiiUi plcu>T 

nod pkuncter. for ivo pcndU. a r^in nod 1 pencil, i-tt- h «t<:. . vc quite 

aoftdoil ncn lor ibc mil fitxiatrtrt jitrruiaiiMi. C^niiin muiien ate 

wvy iiDfMirUBl' -(m>p Tkt Mffkf s3i*M bf ^tp^y Uron/; au bM siJa. 

<b) r** /iJAnwkr ^injfT ihmli V /^f-i%^ attttrttUiy bvi lifk^y ufim 

tk* <iitaL (c). £M(l7y Ar afch aroi mi okA Mfr ^Ai'iiii' !v oikmokiy 

■^k OM if^ jJwwU k ferrmikd, (e). 7A4 ^f^ftnfH-zi ^nviJJ bf to c/m- 

* Thr 4ft<tlur h fti>V« OuJ thctocbaiquc hnv rHommmd^d U nut ik&l in 
gv«rx«l itt^ ta pRVBil frjvni^icf* bu ronvicifivd bun ih^t the UHt n( Ac 
ulnar Mirfnn of Ihe h*nd it mun Mthfect^r) itua the vtnploymtm of ifac 




Th* tink*. 

In ttfh^ 




ping oj Ike ram/ rtgitm and rfmtiant lart of time. (0- TMe ftftt «/ IW 

Strcin£ pCTCUMlon ih uvf J whm l1iri1ir$E 
vraU in wry tut or tntiuulaTt <^^ ivht-'n one 

bvncnth one tliui U r«soiiuil, but ahoiiM b« 

CDdugh to be hoTtl ihroujchiiitT u tKT|Er du.K± 

roum w ilwAya fatJlT aiiJ the Icnn Mrong lA p^, a, Sa,-.! Oi«t 

HcncniJJy mcFui and cj|n--ciaUT *i when on<! ihf *t* »M<fc ^. V^fiiM 

ha« to rlcnl with rliildrra n thin imlt. or wlih .rfffniiiBo^rt 
« noit'tTdEiEutiit IkhIt Mcriyinc ■ rtsaoaiil cine- p«^^.«t^ 

f™"- a:;;" 

Auttcultatorr Pvrconlon.-'Thr 
catiuii uf aLUcuhiiJuii 4ni1 vien.-uHiuu ii a 

vdmiblt procodure in Cdm^h^icnl hin\*U nnH cftpcdDllf 3r> in fIrUr 
ninlrkff ihr hinmdarfn of ih^raffr iir AhdomlEuil nrg^i» And iht 
iMcdion of cftTitla. or the "culn -ound" of pwMxmMtoM- Fot 

F'i#. rid • \(if nl J. 

^ — * *4>**«]^i 

lliL- l«]icr Jt i:& bcsl pnicii9cd by ibc ^'rod plcximctcr" mfllwd widi 
a wntll coin and a luid pi^ctl. ov. in pncumolhom, Avu c^HHif, Tbc 
Artho8iXi]Ji: b \iiiw4 orcr the |>otl to he loic4 iit bounded tuiiJ 

•T^if r«il "jf thf |*ifXar Cnjftt fchct^M t* iiu ^Hiirj ^ tint aiJv thr J-ulp 
oT ihr lip mnl« (S'' |-il?iim4ilrr |ih|t«r» -v^. «t m ^nJJ, Nliufrt* m Hrii^Ltijt ■ 

tbr iDDpMl shnijtd cttinr, Thr nrurr t* hv Sal ihc Iir^i plrximnrr fior urdj- 
Ajtty porpoao- 

iHaU£>s 01 THs TBDunc nscsu—i-Eii.usuoar. 


AS plnor. i^TMiiMJIy Trr^illiii; iiitlfl a jcu'iii js inuFifTl at whidi the 
>pr<i&c DO(< a kol or ilcddtdly chancv^] in pilch and cfuality. Jfcre 
J^trf.ttf jrf imUwn9y unlea ahfupt it >«f>f rrJi^bir. Fhr bmrt- litrrr 
s|ikca, [u»c apkcs. slonucli and Intoiciix an <iLiilc imdiEy lUffdtntiAtpedt 
and. WOT tlic hfo IaIect, accuniiriy ciuilincd by thtc mdhoci or bcElcr 

Hft, \x» conibintr-i; dirrct prrciuaioit and suscultOitioD. No attiikrwt 

Podtioa of tlw Padeot.— For pctcusx'on d ihc a rurri&riiirf^ctfihc 
biMk »boukl bcuiK lao«{> Al the slife: for «n04#7 p^ff UMMi iJ3?y «houH 
be |il*^*^ ■'I'V'i ^ bcBiJ; fur imcuttlcin of Ibc paikrwr inr/iitr tlicy 
«hoald b* dgbtl^ bUed, Mjf plufH upon oppc«if« dimil(f«ri> 

PstCVikia SoUOda.'-lt ttcmioniatjloitcstTibr thr percu»ioii noin 
u roiw tf ji f , hfpfrrttan4M vt fTiu^ttrnVif, </iJJ ^r fial. Sothm^ but 
pniftke ■in lefw to f1ilT«rrniLAlr ihcw lound* but ttny (inc may be 
obtAlc«<{ hy [lefvuMinK »onic iH>rTl(i(i <>( tlkc nnrmal Irfi^iy. 7'^ lypi<iit 
ftdmmofy t u vmant^ ii thai itf tkt t*ff<r jxiih. and its pilch, infi'iisjiy 
«iiij thmtim rfnuid he anftJIy aoinl. 7^ dutt note u yirhied by 
lJt« thw UUv ike ttmi nt^ffin hihI nodryifJ duiMm jutl 4ihtHff tkU 
poiM^ wberp only tht iMn wcdi(c-ihH[ied Ilhib hrmlcr Initncnc*. Tha 
jM iMlf Mi4i> tr WiVtln/ *y ^HflU»i»jt ^^^ '**!!* ** 'i^' tWft*i"J 'nBJ<if, 
tymfanili^ m^te ii yifidtd fry fA^ jAiflVbEiA rtf infrihuf. nt in 'l^niiiSr'H 
1141 qvKr^ and au UDporUnl modirit3.i[chri. vu.:— tfu^ ijnf^ijny 

ChumctcfiiftUa of the Pemunion Soundx.^All pcrruaii^n nam 
ceruib ifdl-rctt^Ucil fhm<tctfwtIo cuvl pcTcuxiic«i ibiclf 
drimnjnr* rr*;U»n<^ «« fril \ty tUt fAr^baMtrr /mjtprr F^ifh iiniiuJ 
kat <j MTftfin qnaiilY. mtentiiy. pikM omJ dfralwn IftUtisiiy dfpftnU 
upom ihr ftwrgy ^nd ompXtMe <f/ vihrati^m; fitch upfm iHt r^pi'SUy 
9} ihe vitntlKmi. Tarring ^i^^ ^^ taukin^ gmatity upon tht \'U>F4liriK 
■Mdl^hi/ Bttd J«ip.iiii*ii mf^m fh£ Oraixtk ^nd amfHtudf of tftftr^Iion and 
thr ilrtui^y »tn\ Errttinn at Ihr aulrrlal, ImrMtfii rfti^laaff ior% 
lMm4 tB htiiid wish JiJiaf4s uJ ^uvdcid by thib alunc a rjcaf mar migKl 
imaki* ■ vrry fair pprciiascir Tbr mav Air the nr^ja fotiUiint and Ike 
grat^pr iXj drrfi dicmraer lAc lurr imwird ji »fi rtiatmrtce. 

The iTorauU Note*. JI it imptH^ti rAal Ae rttfmitl vahaiumi 

* The biUr pi«llK« nnCHfttily iowlira OMswuiliLr Unaiufi ilul Ifturfcir* 
vdik Ibr clkilAlioii <t ihr tr»r K4f. fn 4iucullM hon> bowrvf t, iHepanckm 
b Dftdul 4n dritTmUnc t!ir c<iad{llcfl of lite Utnlubv frfloD- 


If c triRi- 





f^cadUf f» digrrmt af^s 0} She dtfif iJbvAi Af ArtU tk^iy i» tmmd. 
amd Iku4 tktn^ftt ruin earn U i^frud tndv by p^auiakimg pndi^t up^ 
a fiTUnd e)u3l. Tkr apkfs y^dcl ninnnlly a naorunt mie. <lnr but stf 
infcnsr ati<J iradut^ I0 fUC ill pitch (dulnes) u» th? pJcximtlcr (lOfiirT 
approiicha the tvftcbrtJ tin« po«t«rToflr, or Ihr Inchn jnirrioriy. 
Tihff jn/racWkuldf j^oa ia lyiuc^ll^ nannact And Uic pttdi ol the 
pcrowtion nolc u KlL|;hU>- hi£h«r upon the tight Ifcua upon the left 
sMr A»y Icnrlrrny t« apjimuh ihf rrjriuo of « primary brttukut 
mullA in 1 note of hnf^lencd pabcK iAcmiSMl rcftisilBncif> &nd ahortrard 
iluniion (duPnesi) B^luv the right iramd rib &ntcriorty thnv n 
inotued nvanu^ce until ilic fifth rib a tKuhvd vbra ih? pitch risa 
beouM of ihc UAderlying solid tiswe of the \i\vf. Ai the Eixth rib 
iCftNUEkDC cnaca sad ■ Itiic *>i alt*)1utc liubcu niiifk» t^ic town limiL 
of lb* lung uid itt uppCT border od ^« uncovered surftc* of thfi lirrr 
In ibe taiiiarj rajwn tjpia] pulnnniur naoiUACf pnBisia uaIlI Ihr 
«lghth rib 13 readied. Tkt caf^&c dnni tntrt^fUy modifiet ibc per 

Tim. «t - Ulcril 

cuabw noTr- of thr lr(i rhf*i anipfiorly frrmn ihr* rrtwer botd#r <4 
iMrd tBi d^>«itiwdri| williiri ihr ntpplc liEic^ Ali^ni: Ihp i«fiolc idIi 
boubdaij of tht* Tt^ng antcnoriy lN note riRa at one nppooiidw* ihf 
aLfmuoi. The dutLcle la tiiuoUy uxd 15 n plcuinrter 4ad iforcily 
(xrtuitnl, and il» centre yicl^b a miukedly trs^ajint note. Iniemol]} 
and ciirmnlly, pfkh !ind mdttnivrr rine npldly, but m a plriimrtrr 
dw Auth»r bclirv<?i i( fir bc fcllibk and mlflljcadiiic^ 

FatterifT Strfarr —lint the heJght und mnbi'hly nf Ihc flpiort art 
best dctrtmitiH by cairyiiifi ^icnriuvion upward diuiiiic a f^rcrd and held 
HapifAfii'tt. marking the limtiol roBonance. nod repratinj^ the pnxcdufr 
during fotccd anil l»dil apittMHcn. Mcit inm-jLw "( IiitmWty [n the 
puliaoi>ar7 tone iu inspLrtlion ova that of cxptnLlivn pruvtA noibin^. 

DfSftftSttS or TKlt rfKlBATlC VISCITRA— FlfRClTSStOV. 


t ere ad In^fft^ 

6t^ ^ "^ 

ncf- Lane llofi1«ft 

/if ^ lA^ rtiitwifift amJ dimmntitm ej thf iinu 9} raottana ihai it impitf 
tamt The hnvf mii»ck« tovorlng the bu^k mjtice ncrnauy <hc ittc of 
KTcalrr tonr uhI ibc note u Ioa ckar and raXi&f&tloiy ihAn in fnuiL 
Tbk ift portioibrij true at pfmiAHon over the Acapula ]1«eU and a 
gbwce M ft inoMtnc wttkm nr a diat shnw^ Thr futility ni ^ti:Tv\iakm 
ACkf the f|«ne. pAuinj; downward, rhe fiupcrliirial /ii'fr dutrtesi mark 
img Ikf fdttvt berii* 0} tkf fighi iwiijt U cnoatmt^rrd ai the m^wiA rib 4tt 

TU^ tunc Bord«f«.— 7'^ ^^ft>n ami mvbitity 0/ ;A/ fvn; ^0rim 




«M flfodbJ M eivf^ irrvMBt <hrfmi diirtttc vf ih* luni. In lubeniulosji. 
they ibiv M deoded bck of nwbililyT bolh at apex And bue^ In 
ctn|i}jicnM. pnn«ry ut soanAMiy. ^n^UnonAty cn^rf^incni and ob- ]>j,iuTfarv« 
tfracthv dfifvacu of wj type, tbcy ore lower l?fcfcn niiirtmi! ai thr binr. '"*°^- 
jMd n«rfc«ll)r brking in ran^ of mLwcmcrr' In rihniid jihihiaii; 1 
chfoftk pooMiMnia and jilmral odhcakmA iJm change in ^ition ud 

* Iq ^ifcoilni ophjwmk dliv Ion u l«« mntrd \ 

lamiCAI. D|4iCl!V0KK 

raofOnflnt a a Mriking sgrmpUn. In fisupes jo t»^ the napinMory 
rlunga of tht lunjc hordm ttrt datr\j thamn. H mvxf Avt (#*■!« la 
wu4d i/uf off jwimi fwtjfi <«rin(il ^ J!t«U l# tkt jomr fintJf. /W fi^iiiliifr 
0} m^wmfut ji Ar^wH U^ huo li^t it At f««J M and Ituc a oonshkn- 

High Lung Borden. -'I'he lun^ mar bv crowded upvrjj<b or 4Sidc 
b)r jmrmntijil ctuikuiA. lUraip:! hran maliitnjint growitift. pUvnd 
fsudtici, mdcoitam. 4*cbc3 or ftbiciniin«l tuirnm. 

I' MM 


^ f. Nomtl J. Viprrfici*! 

DWce it htAnl over diilfnrlnl. rebxcd, or <pi|jL^KrnAlou> luAg lufU& 
Jn «<iRic rAb^ uf K^ailc cmpliVKcma iz ia jvplaccil by a cote tbac t< 

TympAny. — Tbo idlrnsily and pitch ol a |>u1m4nary tympanilic 
naie lann [^itl)' wirli ihi? fUE? ol ihr ravll^ Jti uTii'b it i>i pr<jdutf«L 
iJic coaiHii'^n of ihc "va^ and the vec of the c»mniuni<MiAX bnmcliua. 
Thf tai^/r thr e^t'iiy. thf /*mw Ihf piuk, iht grtiiter ike «"» a| rtr fMu- 

Skodak Re»<Ji«mc«-^TIiii hj-^icrrriciiiiiiil i-i lyintuniiic not* ii 
I h«Ardnvcr nlaxtd kn^r liauc, u f>>t cuAi|ile« bplcurilifrFffufinnnbore 
ilir IcvrJ i:tf ihf lltiid it\ thr nrlfhbrrhoo^ f>f nn juivindnf^ jmcumnnic 
con»uliiUlirjn, fn c^rTy cdcnin »f 0>r lun^^ jutil, ti^ a Icucr Jci^rec bi 
ocTttin ii4f^ »r fnctplml spti^l i\ilirrtMlA4i4, In Wit fAnclliifln luc 
lumtd it mij pruYV ptu^Ein^ anJ Icmt the [iht^iciuri bito & futile ooirOi 
for » loion in the !««» rinonanT sr^oorl lun^. 

E1l»A^Xi or Ttn THOBAaC rt*C««A— WtRCCWifJN. 


Tjrnipuiiiic Role in Pneumothonx.— Inopcv pceumollkoruE the 
Itcniinkin nule b cxtrrmclv tliuiU'like. bin It ^hrjuld not be Fori^Dticn 
itial in n^fiT cuc» oC do«eil piicuin»tti»ru tfac pcrcuMfon n^und U 
dMcflly dull becauat nf Mgh Kn^on, Thr iym[>;inEik cjiinlfijr of ftn^ 
dole mav be k»i if Unscci mcbn a itrlain pouil, 

Arapboric PercuHioin If<it«.*-Thisho1knvmf4alUcTiak Jcdiatcfft 
Ur^ aupcrlkial catily {ird; ctimmueiltJtjnE wllti a bmnchui an<) to 
fofTnr4 AA to pct><tucc Mlodivc reinfurctn^cnl of i/ibrotioim. 

Diminished R^onflncc— As nanrt' 
uJKC W>M directly with (he amount of air 
111 ihr undnlr^g stmmim Rircnsibic lo ■ 
pcroiiMoD sTrokt. dtep-Mfited ucw ol ci>n- 
KbcUiion covcrH by atr-fonuiainfc \vn^ 
timic jicld A inliiun ai ihe vti^tuUr mul 
dull ncrie. l,u^ •ims of cooMUdAtioi] &t 
(lir furfMc of the hing jrEifM s dulnon pe' 
adly hk« Out of Uic Uvct, 
F1atil«t«.— TbU <hftmdcrisi]VidIy dc&d 
or landcu note iftdicolu denic adht«iiinKH Ikiuiil |Jcursl cffuivkint! oi 
aoli4 ipvwths in dose coM^i witli the dami ^tkUh The annnt\ is of 
I^RM ttsiitAiitc 111 iliiTtJTHttAliii^ llic piuding nan of plmnU rSuioon 
in ttlkkb the bcuih and \oioo sotindd have aJmosl prrcisc])' ihc chime- 
IFT ol ihosr heard iti fniLmonary r[>n>tf4Matifin. Ir a by no muiiu % 
difficoll matter to discin^iush be(«c«& duhcw aod flatncva. 

Special Hodiflcptioni of the PercuMdon Vote,— Itic Bfvti i4 fnt 
fek » pin.Udy ULc Jic "t Jiiiiliiii|i" prcntuccii v^hcn (lit imlniA uf the 
hAtvd^ arc plftcrd bjchtly togvihrr and ttnick ^arply ngiiinit the ktipo 
And in8> bcprrscnl uunually iii (Lctbm.fbutLcdinlAuf crying diildrm. 
In Ihc idtdl cheat il can moat rmdiZy be obLainifd in the infradavioilar 
rvgfaCL U tlUir br a suprrfidal carily wiih ihln waTU and i ^'Rlicdikc" 
opening. The movih siiodd be open and die heavy p(ri:uMUu» applied 
dvrfng c3if4raiioft. Thli ilgn may he pr«nnl Jn np^n pni-umathoAi. 
in the r^uMi at [incuciti^nlc arc**. i>r above a t^lcuid i-rTuAiuii. 

Fr1«drajcfa'« Witnoiuetioo,— Ih* fJtrciMfrion nolo avn a cavity may 
br bighn ikLiiLii! 'lcc]j inft^iniE»D tJian in e^fiimiiirn. 

Wintrich's PbraomfBM.— llw piidi of <he pcrcuaaion note over 

alt ofirn rirhy F^ bi^Jirr «hm ihr mouih » ojwn 

Gechdidl's ^fji^ Tbb leitn i!iapp]icdti>thc wdlLmntn v&iialiDfi 
rn UiP pFrmadon nmr ncrnmfianyhig fhanffrof pohinrr and is oi coutw 
iie|>rii<lrMt ujKm ihc preacntc of nxnrabfi^ fluid ui tlic vonucua. 


1 ;ra«.lhi 
e iililtIrL 

Villi t|ij« 



MiJ)»c:AI. MAOMm, 






fit- jff— LoPwi PcwumoBrt 

ittvMJ, The tulitr ttMHoM^ 
iti-^n 'HI ih* right iM* w«iM 
iiEOE-ni ilic clBtbbciI w^it el 
Cf i»tlil r I ' w *l ^-t I Tur OF ■ w »ilh 
(Jir^nt bfcmchJr I'll" rfiflrtJ 
Arm i>] ci.-rik<'lr-1iiliiA «i4Blit 

Bi«rmer'fi Situ. In jincumdllxinLx Utrrt b a ckcided chju^e b 
.\he notr (■^in'ijiimiJinj; to i:lian^ in Ihf pftZicnt'ft [xotlimi- 

Coia SouikI.— Tbi» b dcecribod under AuaculLatkin. uo p«^ 104. 

AUSCULTAnon.— TAf y^ Jw 0/ ounifJEAJ^ 4€maifdt U0I d^ taf 
ff/ iTTnhi^frk Wit^/iiHf shiU precede ^/ermcr— ift ij^ct- snvdt* hefart 
ttmciu^mg thai 4 tUfcffttrt ,>dM iht iypt »] 

fkmdd bt imTntigaJttL Stigfit syirinrtnc 
dcftartum from the Qomial ak ofte* 

. Bub of AuaculUtory PhepQmeiui. 

— The art ol jii»i.-ulia[i<Mi r:>ii» upon the 

M-mc Tiiwa ot mund aa uudrilii^ paltatiua 

and pcnriuiion. Tha xcttivi hfard it'hen 

tki ear is afpHfd <o lAf ehisl it tkiffy pfO' 
. iiuaJ in Ikt ^UU Khink. but Inuxmittcd 
I and ^ll>difl^r1 liy ih« limnchiaE lubcn. lun^ y<*\A rn r^^ 

imur, and dint noil jTjH murcr rA« mr r.o.tpUr ><^f.rftj.>« i^livurvd br 

. prtdomincfta aj a /hAwW ditmmf im the 

lawtdt kcard. If ik4 H«rmai ptUm^nary sttvelvfe is tvphtfd fry t^n- 
toHSafion. Utf giottU rvunds aft tr<tntmtUi almasl unmodifitd. AS 
dcgrtra of shading auiy DCi:ur occurlLnK to (he shiiiAtion vf ihc atgu 
of tndumuiKi iind their rd&lioa to the l>roBcbL // M«- /oJclb «^ 
iJtiUnvd tung ftr rnfloif /fcvm ifc :ufjiut. a vtikiUar souitd dm h ««f- 

j4 jTn^ modify ikt tuhalar ttmnd AfifiXn, 
thr iarfff JAr hnrndm^ Ihtt is in dirtti 
i£^muHtCixii''m viJJr tkr tuditnMarM «mJ 
Ike murt SKp€tfiii^ fJtt pai€M. lAf marc im^ 
Itns* 1E«0 tr< lA/ iL>Hfnf- Lung oivitict in 
tnmmunlmlinn willi t, bmnchiiR >^J 
DkDdi&i^liona of (he tAcic Rioltic aousda 
nnd trtWav thr nmrr gmml l4vr. lo 
them wc have « defiiut< air-tkambcr iur- 
nHindad by more or km rigid wilU of con»1idfti«d lung linrue; ^/. 

fir foniy imf4y. end if tk4 tfunmntkaimg lu^f ttsdj ht utiJuinfij^. 
ike |Mk snndt Utk€ nv « biitioii, mrAililu or ova viujiui/ i/wilUy 

V^t. >' I'll J r^' l.itmiaii. 

OLiKAnrs or t&x TaootACJc vtKinu — AinctTLT^noN, 


frwm tk4 waiU Of tW tm^y and tliuc mcxlififvj will be irnnAmittcd to 
the surbct o( Ibc dirvt. 
biterpodtion of Air or Fluid bctwem Lung ood Ch^t-wftiL 

tfi tmiumiik^ vHtaiiem, }tcn<t in any fonn <ji pleurisy with ffFuaion, 
bmuli «3VMb »fT likHy t*^ t»* U-a\ ht\<yfi fhr lr»rl of rhr fluid. Certain 
cxcopUons to Ihb fuk uill be i.c>ik3idcTc<l bilct. It Bill U: icadilj 
ia»faiiliiiJ tli^ in llir OH o1 pnciimalh'jmx s frM opcnUi|t between 
Ibc pkurmJ aiiiy wid lung may Ix pirsatt And ihol In ijudi & nvae ihr 

phyoCAl &|^ nould be thof« of a r4;ry 
Urgr ravlty. It in hnnWy nccrt^Ary to 
(loint out the fad thai J^ mlriuUy ff ton- 
dU4Sii ifMffff tnH^ limrtly <ir rA/ tU^lAt 
oaiJ mftn/ify ff/ ths voice ttnii iavvfsely at 
the ihiikiteis oj /hi (ftftt uvj/i. 

Mediate And Immediate Auscultii- 
tiOO-- AuuuluiiMi rn.iv t>c rith^r modj- 
*Hii'' ffkr^"xt\rilnulj *** ^ immediate « Uj* plfwure of the 

Madlfltt.— Ajitotiethoccopc^rt mittien lttilewhAt<^nc u aiwd if the 
cuninca- 'a oo&ipttcnt 1i> jiiIci]avI *hiii lie hwi. TUc i^ljicf I'ucitlubi 
in aajr it«lbofcop< amt— (a]. ^^JmJ if 4hait Jsriz/y £i>AJutfi M>wiid in 
fnfrr-^ditmg frtrm tkf thftt-^tmU to itkr ftir. (b). ThiU ill thru pUat , 
m Ml jAdiF U at % f«ff oJoftt9/r A"" '^'^ fv'fose ^j Ikt irtstturrKnl, yd | 
i«« f«tf kffv «r <if jatfA a /^tm Of ft^ rv-ati' if impotiible to txaminr thin 
du^U «r Am «/ dUMfiBV- kV ThiU iJu far pif<*i an uf a Jt/rm \ind 
fiat lAof «AB tamfir^y tios4 the rxtfmai tju^itury icaai %iikafit 
enrlHif Mwdbff pnisarc. Muiy of lliu luodciu btcilioMujici haTC a 
diaplmipii asd arc c^irdally uMful lA auKvltatcriy percuwon^ The 
atttborpRCeneiMKrtlWof Bttu W ur or Sanaoon and uan on all itftho 
•copo ibc car pkcca of Ihc Una whidi on perfectly adju»iablc. the 
tpriBfl bdng node cd nallrablc meisl tbtt can be hmt lo any decree 
ifcetoL Tlic okure cooifJIoicd aleUio«o>pe» hiLve not pmvcu LutcfuJ 
in the attbor'a handle nor doM b« tcUtvc that Jt ia wite to aa those 
greail|r w gn ifyi pg aoutuL After aU, there U no atcltiuvufHr oi ^ad 
•a the taaiJed car, if ttat ha& be<n pn:'|>eriy traioMl. 

Stttboccnpic Preasurv.— Tbr tym friH^LVTiily intlittt much unnecvt- 
mij ^tn bj kidbk «led>Q9Cofnc presiurt, {otj^ung thai on1)' sucb 
/(vtf« iAmiM Atf ^ff*^ ^' *"" aftwtitfly aJafI tfu VfhoU f$rcumffrttu4 
of il« M IV aW (jbaf ipoff. In the aoacultaiion of lican oiuiui^w 






miM itu- 

by wliicb Bj'Atolic nuroniim vn Inun^ncd &nil pmirUolic munnun 

Quiet IfcceftWiry.— A quirt iJice is ALsdiiidy usmiu! In pxwl 
wori:< for no matter whal fom of atcthotcopc be Mtcd, «t how coa- 
rratnTrd th- hKcnifafi of the phpidnn, nuiildfi lUtUr v^TI urtfouilf 
bterfcrc willi tlic w^iik, 

IsGCrvctlon of Patkent.^ll nuv b^ nc<v«ury To show ilic pcnon 
under cumirdiiun juat lii^w he blioutd brr^tlic, uid ot^only, iheVpi 
should be dos«d and ihv n^intioa be ikcpu aftifcirm, nf>ular ted 
fuM, Mftny pclicnU nil] mAke 013c bmth much (lti?|j<7 iUmi samthtr. 
at much noUicr and the pbyucian b Ukdj lo be thua siulcd U mvl 
nbflfnirilon Pi(«rK The mutirfi ^h^ufd he ki^pi opvn and in anj^ ^"tni 
*J u wcJf Kf Jii^cM to 4 /rv insfinatitms l>rfon: «pplriP£ ibc car or ctethio- 
•cope to the chtd 

Attitude of Pstivnt DoriDf Au^culU- 
tion^-Thv poaiiion of ih« fkiitrnt dtinri); ^ 
j flunfiihation i^hould laiy wJlK t!it iTirlrreni /"^^ . ^ 
oicu under invraiii^tion, prttiaelT aa in I I \^ 
percusaton. Bav« thai th« moat fftfftWt tt- \ \ i 

BfdaatioR of the re^n of the potfierior 
fnterlobar if«cc requires thai ib« hood 
rfiQuld be rarr^ ocrov ihc chul li> the 
cppoaiu ahoulder. The vcftpula \a iliun 
carded forwan) aod outward, and hy ht 
poatortor border very nearly dcfinca the di' 
viikm bclwten tht upi^rr onH ti>n'rr lob^i 

Pnlmonary Arcfti D«mdiidiag Special Attfutiou.— rowTcr. c>f 
LoadoQHhaAeni[>hflfiiaedibe neceuiiyforaapadaltxamtnaiionof cvrtaici 
aiucultailon artt*. He shorn llmi lubercuInsfH nc«iiy always firti in- 
voivca (he afc^i; not ibo txirvme <ip, but 6 potni run^vr lo the poolcnoiT 
than [he antrrior surfacr and lumeuhul rrirmAl. ttnd ihat it tolIov« 
adefiDiic"Zineof inarch."pa»Dnf dmvniviirdii'nf iftfoihc upper port kjn 
of the lower lobt al&ng Ibr inbrriobar future, fleneir ihe idom impar 
Liinl utn >rc;— <a), I'mlrri^ly. al a point ofptot^ Uic mvnd dnrsat 
SfiiHf bul K^t ff^strd tk4 scaplda. {t}. AnUriJtfty. aL 9f pml Mffw 
Un mWl4 t) ittr ttaviiit. (r) Tkr tupra- tmd inyiUcaftiUir sptta. 
(d)» Ahng *W *Mn<r fe>rJ>T #/ tke ttapnia. apftflf thf h^nti f/ thai ride 
p«» vpim tkt rpfontt ikgtiUn. (c>, TIk upptt part e} tJu AtitUny 

t'»I *n 

Y^t #> -An lflipi4t4lM 

['uLmDCufT TnlKreabvM^ 



iiy, ^fforfHtk, m ^ tntt imUrtiiry. and, Jw lUfmil^ ^utt bet-j.Yfn mifnrii- 
Ikm mtd exfinii&n. The iktxet luu no mnrc Uiui nnc-third Uir JuiuIijq 
^^jl ^ Fo4«M7 tkn4 mar ^ tnoudihlc in ondJnAcy LUscultLlk^a. 
^^■Piierlle or Harsh RcEpinitkiB.-Arivnifil— In ilirchcsl of KhUd. 
^^w ahva lieicBiDK o^cr a lunf; liial u pcrfomuni: vicarious dutka. one 
he^n lb* io-oUed pu«hlt tinalhing, ikbicti U pniclicaLly intenjll^cd 
vokubr se^Bntkiii. 

PaAtUpc — Ovtf the UBatfMtcd luoji iq cdmi of pJeunqr with 
cAuiinn 09 |nnjinont&, 

Pnkloo<«d £x^ntlofi>- Au'dc from tbe alridor ^ ob«lntctlvtot 
«pu«qnodtc <ljr«faum a Rsptntory totind poasru£ng thi^ u In mom 
RUTl<d ctuadfdstif H frcqucni^y bcud on aiiACulCblbn, and suicersls 
at tinct X djQtciaiij in th« ctpuUion of ur from the Ivngi. tf tht «xp{n- 
toiy aoto be faij^ [>ltched, a i^nmll ivu of ii^ftratjcpn ui mcUaiIcd,i if 
the pittk be bv. ib«n cmt thitvU o( disicrttlon or rcUiaTi^sa ai the lung 
iKmu^ mth M Qcrun En rmphjiiwmA. (hn-nlr bnmrhirls. i»r jutaa 
iamcdSatflr ourmuodb; an indpicnl tubcrculoiu <lcpDaiL 

gUp p tt W d BiMthin^,— Abftcncc of ihv bmih-voucdi ov«t any 
pMl ol the kmipi jndkftia cvtIicT ft«blc brtatltb^. |}k latcflpafitioik of 
aaoie ukmortcc httvntti the lung »nd the chcsl. or art obiUmcted 
btfcscbui. Plvurbr with tffuaioQ uid pLcunil K^owLhs oi iliubriLUkK 
npcemi itc former, and ibcrmcueeoJmMsivfr pneumonia, prc«auic 
of gfMnIn or anvurinn, ca ordmloo by forri^ botHra ihr btler Siip- 
pnucd biulhinx U tomaioa ^1 the apci uq indpicnt pbthi«u and Jo 
1BQM condilkiai bi which ilicfe it okUa^ at lunjf tissue. In broncho- 
pftwflioofa A» b eariy uplcal Uibciudtjaif, i.(;U£]i. or. in tlic clilEti, 
Cffinit mjy dtvctop wU dafintd broalhin^ or iiii;;:t«uvc modklicationK. 

C0K-w1i««] BTMtblnf • — Uudi oiinB hu bmi Jair} uiioii ihU as a 
lymptoai oi toiij phthttii It Is over-nkd and one should Hmenber 
that mm umaatae^ prndorefl nuulceil ditiiirbanrp of the beart's 
KlioiL, incpdar and iilie<lUil Jn*piralion, uneven miucular (onlr^tii^Hk 
uid thereJoM pwewfe oog'whcci breathing. Ij gfruunt if tknitd bt 
heard tt/tm wkttt At bfoiikmii it rrsitiar attd d$4p, »td skt ht^rt aditm 
iWftfA<y Hn4tdy ^ridsmi mer grtaHjf atxtitrakd, 'tic term "cog-wbeeV' 
ia not ilnnipCivr: Ik hnathing is Tirttvy. and marktd by dittiitft hrrals. 
Wbcs scfMnne it indkftto impcrfctt cjtpansion of some pordoo of ihc 

BrakchUl Drcatfam^*— AVmo/.^If a sLttJicoi-upc be pta^icd orcr 
the atvanth otrrical cpift* bmoduai brvaihing la besfd, U d^gmfrffm 




eiTeri of 



ft«*r till , 


lit. ft/.- hl*]*cri*«( '>tv«1^ 

erpifotiim arr ht^k piickrd- hetv^mi ikem U a tOttitttl ntCfrm/. Exfin* 

thai of imipimtiMt. 

Palkolvgic.—Such bn»lhbj£ inilkjUo ccvuolHlatioii m con 
of lung ti««ui; ia docc nUtioTt to a patent bvoficliutt. Thva it u 
in pnniTniiTi isi and phliiitikn nml ovrr luii^ rnii^iiwwrirt lijr foedttstPMl 
or other lujnun or pcTicnrTJi«J cfiti^ioa. 
Pot <h^ amc rruon prntubly. ihr voici^ 
Acd breath- louiidi Arc ncll condiwtcd in 
noQoe ca*ec ol rffuuon but m vudi ihn 

oimcl (Lmgn<«tt arxl iJiv bn^thiag «| 
iBUiil]> diit'tnt iliriugh lul^titar. 
Broncho-Vfekular Broatliinc.— 

<rvtr ihc K<<ii)d inicrco«ul «pacc At tlic 
>t«mal borW. or upoti IIm upper tntrr- 
Kapuhi rr^un oi Ua* numiftj dim, (he 
•nutivl (onductr^J U> ihr cor b d OkTinx 
miitt^ oj wikmiitr and hromhial tiraitk- 


i'alkdjfgk. — Tijcrf i* nn mow Import- 
aot dinitaJ atudy Uuin tint HFxtiTicaliun. U it irtquentlT repracnti 

oktly i\ib^Ti^\*is[a or il«p suj^^crl cCOClftl COUMlidaliolL 

TubuUr BicnthioK.—AVmflA— Tubular bfoUhicig la beanl nor 
Riallr over Itic jtliMtu aikI «^~]^f /rinn bfvn^ial hnat^tg in Mif m^^ 
im^HS* and f^rffuing a peaaitof ivh^fUg qvaSUy. 

Patitckik^—lli pipiificanoc when beard over pulmonuy area* ii 
found in iu auodition wilb «impl«1e tnpfrfnUi <ttntnU4^iam of lucg 
tiuuc It i» iirpotlvit thai ihl» bivatiiiEig sbi^JuU be toieruUr rtudieil^ 
bccfiuse oi its intimate nw^iaiioD vithn or near Likenen to cavcmovt 
AAd amphfirir hmaihlnE- 

C«v«n)ov» BrcAtbioX- Tlw *ofc imporlantdi^cffm^ hft^rtn CMvm^ 

<i|if iTfj/f tutntl^f ttrfiUiiing tin in tkf fart tkiil in :A/ fflnur Utr pitch It liiw 

and ifte ijualily di$iifi£liy twt^ouf. For Id protJuclion. a pulmooAfT 

[ (sviiy U Dweoary. vropCj or paAiiLliy «o, and not Im tb>n ain iccb 

^a on.) In dinmrfcr. 

Amphoric Bt^atbitig.—Ampkffrie brtaihiiig is fJMcUy ikt ta 
toMmaus, tttvf rkai ii pfujiini <i mtUUk m ntmrU^ qmdUy. \hK xciund 

»vlr4j4livn>. Thi «itiffi4*>U|itf- 
fMiflt m**» wauM iirrv^al only 
'lu)*'**<, 4iffi'rti«V»r4 ■«••* inn 

luni ^tn^r.»^ii« I-1 circled 

>W4f I 
tCKind I 

pem gK ft o* rsx tbouck racxaA-^c«criTATioor 





■nnnblDg Att produced by bbwlng acrotf ihc tiiouih of an cmpt^ Ufuii.f 
bottle It b hcArd over bnc^ aupcrilciAl <4Titk& mwi in op«n patiano- 

thcrcuE. tit dt €^US 0j Wmfy JrfT ^rewtiial urmmunifatism is mi4ttary 
Iff lA« /raJ«htiM 0/ iW 17^^ itwkl. 
VoctJ R«Mnuic«. -Noffn^—li the earoritalhiMcope be Applied to 

ibr iDElTlin- rr^jon of a buJlJiv ^hur. afifl ihr patJrnr hIowIj rrprait 
ibe Tonl "mnctj'nlnc.'* ihc vcacc h \K!if*\ but (be word» <annnlbc 
iHtftiyilifwd' mnrroTfr, the car rTHignLjuv Ihe fairi thai iho nriimfl k 
pn>4actd BC t pcJaL aomc iljBEaftcc from ihc atcthoacij|x. Sucli normnl 
rural rMonincc is ftaaociated with a vnicular murrnur an4 a ncrrmil 
pcftvswuti notr, bui in tfiacuc ae find miJilioiiA to fit «vi-ry variety of 
abMfmii] brrath VMindft and perouaioii tones, 

Bicmctiophonjr (tn-infMnl mirr) — A^flfwuJ.— BmnrhriphnnyTmiy t»r V'^en 
be«ni in Ua i>unaiJ clioA 4vrr die monubrtumt Al d)U fniini the '^^"^^ 
rokc or whiipvr >w im to N ilirmly at ihr moiiih 4>r ific tfrthiw^n^ir , 
>ac| tW 9cmc of Fcniotcocstv »o niarkctl in noraT^ reaonancc, ia alto- 1 !]^S[**i 
^ihcr ktft P«rJMlpfK'. Brtmchr phony is bard itt voryhiic ^kgrrvs i^n^fM^^ 
qhHet the taiar rundltfoni Ihai fiTQtlucr hmnrhmt »nd binnrhovMicTiUr ' f^**''*'' 
bn«lhui|;. A Uittt brtiochophi^ny i« «oinctimc9 tcrmcfl « "limnchiiil 
wbliiprT** liut ahwiM ht ci\M "ditcnnf *' nr "faini"* to avnlrl irtnfo^in]^ ' 
It *ilb "wliiaintrd*' bruiKtiopbonr. 

P«Ctorilc<luy ^trmcbvol vwc*)'^A'ivfr»3/.^rrctori[oquy cormpondit 
to tbc noraiAl voloe u hcutl otcr :hc ti^uihcj, 1l cliiTcra Fr^-m bron- 
cbofibony in ihat ihc words nccm lo be duliiicily onkulaliMl and i|>ohen 
diiTclIy iwita tht mr, WhijiprrHl pcctorllciquy U i!u* irrm AppKc'd whrn 
the ■tiMf iiri d voice ta thuA innamittcd. 

Potkilc^.— It iet hnni over >up«vfciil nvifin m^ mntoMi}ir\n. 

1acr«as«4 VocnI Resocuwce of Hci^htoaed Pitch.— Vocal roo- tinLwridin 
aiDOe nujr Ik only Eli|;htly inorucd, with Ji n;r IH piiiM la CAMft of iiQ' ' 
pcHoct coa»lldaikin nf lun^ tlMuc^ or ia cxvitia that are not mi- 
fomded by fooaebdAtcd luajt tiutic, 

Bg!0|dlOfl J.-* PfUlW^jf ir. — K|enphnnjr if a prrull^r modiArfLtlijn of 
tbc v<tloc-ffjuE»l that cveo it a blutmg or diyfimdh ttoMl character ounner. 
Il ii xntM frequently beard M ibe upper levvL of pTeuriiJi^ efTuiinn, and ' 
ju9l abort theuTAofadvandnflconfolidalJora m pcicifmoniL Attention StvulA 
ii QOl inJnqucnUy dtfc(««d la Amall ptturmi cfliuioniw acute ot »i]b 
■cute, bjr enroitnterinx ejeophony 11 ilit- infrrior angle of the- Mupub- 1 

DUnislftbH Vocal Resonance. -I'be loUowini; conditions mub in I 
dimatiEion or Ion ci itie ncinnal vocal Fvonaace: ' 

^«nuf. (a). Weak voices (b). Kucesnvdy tlilcV v^\. Tottio- 








Jnjpff. (a). EaDphpcm or nJu»1 lung fRim wfaatmr causes; (it). 
£Jhi»ioa i£lc flcurtJ cavity (liquid ot jpaeota), fc)' Plcunl |{TOwtb 
DC IhidEtning, [A]. Mweiivc p3»iinioaJft (Ut|p bmadii bWked^. 
{«)l Octhidcd brondiii* Juv to foreign Uxllc« oi to pveMurc 

Echoing R«gocuic«.— 'ttc :ffin st^und proper U ApeculUrbdl'ttr 
U*M hojjiL u\r( ilrt: AlTcilnl !tiiU' ill p(icu]nultiuira.\ xlini a tuia b |jAacci1 
ijfhifi thi: chtot and lightly struck with aroltm. Tbr •uscnllMof 
luually apgilia hU cas ot «lfUll^s^^p^ la Uir back And ui un'suii 
muupuUlci like toin upoo die uilcnor »iirlacc of Ihc AcM. EcboiiiK 
nramfthnricmnnAnceof ihevorcvftnd hcafl'fKKmdinuf behc^nlurKWr 

RALES- —^J/f] *ir>f fdhfr dry tfr moiii, a/id ■ coatidtfDCiOQ of fb# 
aiuLaniic ainicturti of llie luiip ^d pleua inokta il tsay 1o UDdersuad 
Ihc mode of their production, ilicir tiifisiScimcc ftud the fusing 4|«aliiH9 
dependpiiE upon the conditm of ihe lun([ lisdf ifid die duuiifteT dI 
ihc mijinilnn. Aaidc froi^i tlic frktion til^ dry ifllet iMf be divided 
into iva groujH — (a) ^'^Hloni or whi«ltiiie (b> .S#<MrMtl. "•t <MC 

lane rifwitibliiij xmiriti^, nl AJUHhef llir sound of a buuon. and very 
bcqucntljilislikcihcoooitijEof atutlle^ave^" Thc)m of ftll ipadc* 
of |dlch And Intrnxfly nnd fn psumng from i>if ver^* frrhlnl sEMlutT to 
Ihc moal reucoiu moci^^iua rftic ^ 4if}trtn<ei Jj-^J uf<m tkf ntt of 
iAf tube iti whtth tkfy ^n produfMy itt prKC%9nity iit f/u turfa<r.. r#4d> 
tkn k ihc i'intscli44i€ti ivroj. t^if fA< dcptk otid diofinkr vj iht tttfi' 
r«0tMi iMf. Such T&ka tlonc or in UMOtUoa with olhcn ue 
Hunt frcquenily found in ^ininchUI olMriuctUaip bnuithilis^ i^hnu juid 
cmphfMmft, but per>I^iepl rlry lilu uv common La inrifucrrt Uabcrcu- 
kffU utd fTiAy br- dhrinrity reocmant cr oanKmaifn^, 

$tfJdor.— Stridor islhc loud Miuid beard <iYcr the trudm era pdmary 
bmnchiu ihjtt ia «liiliuci«d by onccfump luTnor or a foreign bodf- A 
umilAr XRind is henrd ia iiiirzl>vU of Uic Abhluttnn. nch as majr nsadt 
from pncnm upon the racunvnt lar>n|{G»l nerve. 

Molvl Roles. In ihr umsitWiLlitm uf rmiiftt rilfs Ibe fkirf fvinU Or 
^ th^r-ii art: ik<ir quaHty. iht. piUh, ^nd rttono'Kt^ A mcfM Illc 
viaj be produ<pd byieiplnilion at any point fioDn Ihf ^^tiii 1o > lernunal 
alvcotui ond taay be due 10 the juivua exudate <4 edcvUi the muooiia or 
mucDpunjlcrnt «ecrv(ionof bronchilii^ Ihc thidc irn&doui «puia ol peau- 
iUonia.orl]icpBru1<niltiiti1cif ^jiulmunaf? cavity of |incLimi>|:^tboiVL 
Bdng oltcniimct ajBvdAtcil yrith cxmsuUdntiun ol all kiadi, or e»Tity 
of any degrn. It mwa varr in pitdi, qualiiy, nixe nntl taiennij vriih lis 

DBSftOtt <« na noRActc %-iscuu.— iaus. 



of linx «oufld* compuvd to th« <rs;lttirg at liumlnft ull. or 

the HiT- Cnpiiation i> net « hqmi riit but ngni^n merely ihat air « 
eiiima|ttt10Na]lb|iBrdvciii'k.[ir. n-pmrtiuliricplcuniKrLctHiniirthe 
MpWvHaa of tb'i^l^ adbcrcat pbunl Hurfoca* 1l is unc nf ihc CAfly 
■ifV d lobar pnemiMnit {4ttfiiafio taJux), licmorrhAfeir brxrciinn ftAfI 
iBC%QCat liLbcrcutooat; occun aa a prr;:Lir>ui vi rrtnlutiun (<ri;^ktofkr 
rvrfm) iod nuy nomuUjrbc h^nrd at the apex orlxuc of the lungwlicn 
the Gm tkvfi iiDfri^lian i* Uktm. Such itic* ojt oUn hmnJ pcrauteiuLy 
At the baae of tb« limit ^^'^V ■'^ pulmonary edema and hrpoetalie 
m n ff ^adn u . Tiuy an luard always iji ihf. rnd n} df^p it^pirMitm 
vkd rmj be oenfovDikd by the tjm wilh aupcHicial jrrrmurc rrepi(«lion 
produotd hy hb own car or <EMbo«CApo, 

CtAckUoc ft«lM*f— Thror vaiictics of cr>ckJe» are rccojcnbtfU by 
the diipkOAidaa^ Tktfmt twackUng or wbcr^pilaiit t^tts are prodDCMJ 
la ike finff bfooichi bcArl cbirf^f but mil ticluiivdy \n [m^p^rii ii m x^u\ 
bdEcAle, » a nik. ooniiAcndnic ■ n lilt m lion. ElcAnl M (he ^iou. llicv 
fthra^ iiMogLjr Mg|^ an bciplenT Tiibt^rrular proertt; at the ki«f. 
pDcuakfvkii or coogtstioa. They atp h»i<d «atlr In rtaolvtng pneu- 
nook. Mtdivm erttckltHg r&lft are of Ibe Mme jfenefal nainrc » Ihe 
fuTEfiuing, bm cuaner Thi-y an: Ifnnl <>\Tr Ticrftoilnp tubercuIoiLh 
ansc bnocfao-pncumodia, and re«:iUini: lobar pnramnr\i4i. Con»o 
nanrv b mul«ft ta tbi^ pn-smce i>r mrilLnttirin. 

La^^v, Cncklioc RaJti are sUQ coarser aad nwrc dbtinclir fluid 
Ihaa 1^ bngauig and point uwiulljr to eitensave soflenmg in a lirbtfmi ■ 

Mncoiu Click. -This •ound sUn<U mirlway Ulween the cncklinf^ 
iAii the UibbUng nr irirj^njc rlln It h a 'siieL^/' nii)Ci>us crackle 
uuM&y aai^ aoid eonunofily hoarJ al the apico in tuberculous^ 

BUbbUnC TUlet, — Tbw may be sm^ll- mfrfiumorhrsi^ tkjiiM rftlc^ 
and ore UMally readily cecogniAed. Gurgling Rales,— Thcv are 
Ufuafiy bMrd oreT large (Avitiet duhng cough or in foiled irupiration- 

VtUSx aad Rcftooaace of KaUa.— 4Ji ucuwiV^ <j/ nt/^^ &dtr« u 
ecriaM ^Jb ond i*grmtr} rfi^»aMet,tHrittiy aUriMahU Im lAeir turrtvn4- 
fKfi. One that b ptriducrd tn a bmnchiu or eatity mimiunilnl b)' 

'Thrte ta rmaiaJy a] rr<r|Titifina h^wHy di«inguiihaliJp (fom 
alvmhtt rrrahaiieM andn a anre pmn'v.mrnl pleural <mckU. 

tTbe Bunnv bcttera lliai literuf clblinipiikhoecdEvadiJerroix bvlwrtn 
uiDfibcn IX even luge cracklca and ilicumiUaTliui m(ireli<tuiJ " ImUAn^^" 
flies. HetiCf the claMUcailert imd 








€noaoll<ltt«il }img X'lasnx nr atdtriufs will htn noMXiy of the qiiaihin 
of ivbulur or amplii>Tic brrathinis kencc vrt vpttk o| rmnfmi ilkVk 
uJkimg lUa. cjjnsottmfiiiti itlA. etc.. jmrl ihrve maj b« dUwr vobl 
or lb?. Tliae u« cciuin sqmiJ wunds of xmc mtcnac Md dud 
unonjt these tn "poKAtMtlve nction," "roetxllk tiftkliag" and "sue- 

POGI-tOMiva Suction- ThU inUmMinjz phpinl fli^ ia piftlhoj;- 
nomonk uf i:&vii)' fomutEiun nnd hti bMn aptly Lrnntfd "ihr indii' 
nibberbAlI" Mucid^ It b Auppoa&d to b« da« to the cqamioai ol ■ 
ntUipAMl ihtii'ViUAl tftvin fiimniiQlcsi]R|t *'>!> * bronchuf. A 
UDbilir but wtvct and KUiidJi^K ftucliun sound rlllicr iiufitraluiry or 
ex|iir«Lof7 md) be li«sH ifi paeonotborru U conununioUkin vjUi ihc 
lung W2d» 

MMallU TiBkliD^.—This itrm u applkd to ihc bMuliful mtuiol 
sound samAiiTiM hi^rd over n vrn' Urjjp OLvity w^ih dnuip imoolli 
waU* or in pncumoihoRU- Ttie- phenomenon U really due to iht 
^irodunlori of cfhosa Md wbao low ^ichod is olitn irvoMd junpboric 

Hippccrntic Succu«noii.--Thkiiihcwtllbao«ifkswa«{uii|tfloi»d, 
ofttn mriollu-, prniliicri:] b^ ihi* «oinf!whjtf brmJr ttwiAini? of «hiil:ing 
ihc vkiim oi • pncuni4>hydn>- vr iiyn-tlwrnx 

FrictkiB Sounds^— Tnir fhdmn a product b;tb« attritkaul is&funl 
wiH&cc) rotigbcncd hy iniUmmaiHtn and b uaudlj umnisUkiblc. oftfo 
pdfubic- Tht f$taiiiy ^} Uu rowid m <ftaJkmg,iMittg m a^Ming^ 
ii is imUmaHiy dUUmiiy jtifierfidal. Gtmmody £nJ heard in fJhc 
SMlIarf dflitf lM/ram«i^inKtf> rtgiofU ar%d tU ike ^nitriat lung; margins, ii 
tawitiy dituhlf in rhythm, <iiMf vkfti ii Miii mnr< imptvrk\M, i\ o-ueditird 
in m0ti tatti iriih ^in on deep ititpir4li'in aitd is uttafttkd hy i^ngk. 
Fri^ioEi riSe* tD».y peniic al ihn maipru of dutnns due lo pleural etU' 
ditc mad thclf mppauuicc indioia abson'^^"' t*iainil ^tpitotiim 
MtuaUy occiirt tar^y m the tnfipinMofy ptue cif ibc individuol bnatb- 
wuad vrhcRSA ifut cnpiutlon 1» Inic but llw iliftTinr(iciD 1b not alwftjs 

< pcnatblc, 

CHEST- — The impoftAncr cf llumroacopic and ph^totcraphic mclhodain 
the diagDoiit of duewet at tlic hcrari. luajp ncd pUun m too httlc? appn- 
data! b; the avtraffc fJiysJclAn. Ktaonooopfc rtanUnation has been 

«11 te HnratBf^Jy iimtjUliKl by Ih# toanH hcoril vhi?n thi mlm cif ih' 

< hand U prpttf^ tna\y i^iiui Tht nr aad Ui? dotruRi nibbrd b^ thjt fat 
I of ihr Anger fiLtlp^ 

Dif cAnc o» THx ''*»'"^ vnnnu— x-ttAY. 


• pvt of tin avllKiv^ icnjtiiK mctKoO fur scvcibI )rcar«. And hju 
prom U«U indHpeimbte- EUher th« tuik machm^ or llif coil vny br 
utr(\. iht. fnrmcr having ir Its to\c advuiiKgr JUi applitability tnlUifrapcu- 
l>c «K9; lift coil bcinjE much inoTc convciiIcDl on occouni of Its fftaicr 
TfWahWity and th« Otnrt HnnF nrciritfyl 10 piti it In ciprmtloti- Full 
initruclMii rr^iniing Cccliaiquc b lo be fMind in booka <IcviQlC«S capcdoUy 
to thai tubjecc. and il need only b« stjilrd thai, {a). ItAtt pf midium 
rahivKt x>^r iUc hrst rcttdtt. (U). Thai wihmimw apo\wi!s sht'dd hr 

Md. At "■V<Tlbfr<) l'4[nriiE-^ri liAfCflllnU* llijEM>]r f 3Vir*H ft| 
i4iiw«u vlih 0cvr«itnilf<l mfllTCBT^Hi n If n !>»*■ 

ft ^ di ^itihU. (dj. rAd/ etpniiJ tare sJn>vU be ifbstrvfii in fjb« 
fdj( 1^ ^ulietif to^'n; on itiilahtr or diMiiitd ikin^ (c). TAtif Ihp 
tame l^vt ditiane§ shmM bt chttrved %h twfy loif. Tbi» U <?rdiniril7 
15 [nchn frnm thr Thtpi to the Knrfjtrr of ihr hn^^ I'hU prrc»uiion 
in apccuQr peccMuy for Ihc accur^le <vmpariM>n uf cib»crTaii4Q5. (0- 
A iJum/gk ^mUiaHtf vtdh ikf fwfi*X^(fi{. App^tr.iaf4s 0/ lAi* mtrmt^i 
tk«M M fii4»j/rMa6Cr, (^, TJu optmler mttiS. by tht iu€ <ff g firoprr 
itrt*n» fvtmi t/u tx^^tun a/ kit mm k4u4s. itr be pn^rsd for mim>r 
hmm viMiA may frev^ tJtirrmdy trtmhkjttmc. (h). A rv^tUivf iiriU 
»flm thtw ■■*« 'Ajw '^ fMfrMt*fii€ pkluff *»■ fitmkt4 pk-^Uff^ph. 
By Ihii niibod nf madnatlon aku oI pnoumciik^a. ol Ufbn(^W\ 



KiLCV ill* 


Viliu- a( 


pnctjisn or tok travacec? v7<o^a— rorce. 



»vcnttn|cly inaUund inrolTcment bilaTcnl. An kiii^ij^iJCtKil cavlljr 
nuLj ihaw plafaulf aa ft hhflbt ttfUx. To dicnwn of ih« ht^rt ihf X-Kty 
ntcOiodA JUT iniikiibic for b<tl cniIj b tijc cArrliac aiiilinc dcArly tnd 
4ccimtcfr d«fiii«iL bul tb4 esriir diagno«i* of ant^urum or mediastinal 
growthi b DUife poaeijle. linked it h i^ eniy meihoft by vAkk it 
^Mitfvtf dUpvtis of o^Nff tfMfvrifin cam l« mai/^ m ih f^rty sto£fj. 
TW omfiM of Ihf diltimdrd aorta U pUitily Uiawn, an^l whiE It t^aiir 
as foipOTlanL GXpwia3c iNdsfttka. the tint qtta u^n uf diaicaoau b niAik 

F1ooro«cop«c Sipu 4Uid Tbdr SicEuficflnce.— BnfAf /i^ft/ rr,4u 
in titf^PH* «M^^=:iaritT. ^^iuf jbAjTu^ ^ inlUtnitioa usually tu 
bcfCDlnm. Skadnn df hase^. pneumonbu cnnpournn, AflliaJnnft nr 

■t^Hf 0/ Jh Jhwri Jill ior^ hrtcHfim^ ^^ plntnil «fhiKiAn . S«mt tmaiSff- 
tieted with tattk ^tfihunmi^nUi pkur&L jidlitiiiuiru* nuJjgiL;»it 
diMue or cubduptkngBiJlx ibtcttt. iMolwd shedtru} miiy indJcoii; 
tAjtKtm tn malignuit growtK Imolbcd lubcrctjloKis, fmctKn bodlc*. 
mcvskd plciirif7< The dimiaJ tym^krmt itaad phytiecJ tigm of course 
indka/U^ ibf loilf. chpimif. pffmar^', or vH^tniUry fi&Dir? <if (h* Iwion. 
CODGH4 — TA* ton"! CMtih ttrm tinsf^ <» m^Upk^ ^MJiXttfrt-c, «*- 
fUim. trpin§arf atSt frfft4'J hj a tp^srmodit ghlHc /i^/irrr. li mxy 
•ripe frgm 1 nmldiudc oi nausrs ant! Ihc irtiuucm tff widtly wiminif^i] 
tnd dlvrmr rtKJoiuL Ibouiih oommonly purposeful and intended lo ff- 
tmOTt Ini'xlitt^ mAi^rbtl frtim iltcl:rr»nchlortbtuiix. lhiit>elTij;ofiliiuri]y 

secralfo* BCConipAnyifLjE nmic or rhrnnk iianuc of :hc nii puuj^. 

foreign bortin. Tkf most tmiitn'r rr^vm^ are Ihr inleraryl^rndil 
»p«(f. the ir^cbcAl bihticalJb&. phftiy^^^ ^m^k ^^ ^^ looguc. nui>-[ 
phvTaie tn4 cerUin srcttft vi the nttaJ poaafis proj»«r- Many forms ' 
of rrjinr avi^b finiT obntrwil 4J|[1 thoc hbouLiI nJwiiy^ rcrrivc CLXi^idrrn- 
tkn m iiuuncn ol ocberwbc incjcpUcabh pvisUtio^l cough. Amuld's 
bnnrfa of the |innmo-|pittrlc avne ft &ctic>vnUl>le for a nirv cuu^ 
coKitecKd «itb irribuion oi thf external auditory coooL" So «3bo 
(knilng of the «nr1ftce. prttamw upon the iplem ^r Itvpt. or the various 
JiLCMMnj of tlir fiver o? j^blikildcr whrn a^^icijilci] wttlt involvcmcfil 
oS tht dfophngnvik [ilranE; and finally, in women, chnvnic (hivue of 
tW piflvic oqi^nh i» ah ixiaAuiriAl (jium- ajkI Rt^ili a i^nif^h frt'i|u<'jil1y 
di9tt|>pcftn entirely after op«ratMft. Othiir cDu|^ ore pufvty neurolic- 
<nth are tbe olxnuhv kjntirhi^ ^^^^ *nd Ihe barkmg C'?ngK at pu- 

* Such « caat n^f otlf u^act^rd bf the niiiKfr W4i ptijmpdr cd per- 
lir rtMrrrd by Ibe rm^vrat of impncttd ci?uBncn> 










bertf. DMlififftt (tvgk in infunu u ptxrdv tv&rot in duiracicr, bM tlie ^ 
xo-okUcd jAH»«dh CMf Jh, MWkdvEcd ondinftrll^ wfth rhnmlc pftrltb aad 
mofl fRqwntlf ob»trved in rlrick«9« i« no doubL due to ihc dcoofo- 
|tMtyfng fihitryn^'titt anil ih« umf tiaiem«ni applln lo the ffw^k^i 
fONf A And ill ajW^iftcM Urfnt^^ Moriy c4MS of C3nasit€ iVnlolUm 
0/ amtilw tur^ttQte'att^ u« ob^ncfl. {iftrliculsriv in young ptrt^'k 
ftni) neumtit, En(IUiduah> ibc u>niliiIoiu bdnf 'cr^' similar Da iIkim jm' 
KKJufc^t wilfi asthmatic p^nixTfJ^^A »n4 hay fever. Il should b« rvictcfn- 
bcm] iJmr irritolii'n cf Iht lunt; p^Jrnt*kynut dan Wll COMSt CougA. bui 
unqu4fitioniibt>- irrifiUiott of mjUmnMiivn a] 9k§ pUt^n db«s. haicc m 
fuimffvury dittaM. acutf or ckrank. Ike <fiugk it attribMabU Htktf M 
hf^rmhi^ ar ptfMrai irritatioH. Agun Jl should be aud that iht autmt^ 
Ami that any cousk >i rffitx or naiftiUt th/mid ht ^apvned unlUaU 

Dry «fld MoiM CoolkIi.— la Jndpiriit phthuu and th( tnxXj suiga 
oS branchinl mmimnaticji or imiati^in from nh&ievf'r niue tht cnufifc 
ia uHprvdmtivf. hence h b termed ifv. It ma> be e^ttremcly mgtrU, 
f0foxy$m4t. or pamfid. Aeuie bron<hmt. preumotdt. wboopjng CMi^ 
asthoui* and )j]c!urby fuinUi llii^ bm t^amplra, and, in Ui^ic rtrlj 
ita|CV«.prmctioiiUy all of the niwoui, rvficx. or pressurr coufl^ arc dry, 
irA/B pain ix prtsrm an rflori 1* tnnrie 10 lupprrji the amgh ju In ib« 
CMt etpecikklly in ViUar pneumocu uid plcuruy, /"arofyfuuj £0i|f A 
bM 'lenifilirierl by whoc^'ing oMigh may br enerninierNi in • lug( 
number of c^jndilioai whether due lu direct cirilaliun u in the ax oF a 
Uiyn^etJ tumor, or to reilcx oaumc u in unpoded orrumcn or turges' 
OHHV of the nuaJ pftangei^ ooil in pcrtnuU phn^cuUriy xhh pKrotpm 
mAf be ww>ciated with vonkilinjc ocd cvta with l^emorrhAj^ uiider i>tf 
iMifo and rplsiATlb, 4 ^/ni^ijv^j /^«f/i may af-^n hr c^sarialtd Mvth 
tke actmmuiitlioH oj rr^rdint jind attended by ft pTxifuM and periiaps 
fuddfc discbar^ aa Utr mmpl^ in brancbicctaAlit, crrtaia pulmonuy 
oivilta or the ruplure of absccaaea uito the broodiL PravKn CMf % 
due to mcdiaatmot tumoit. perir^rdUl «ITtj«ion. etc,, may b^. but onJi- 
narily k rol. paroiyKmal. Tli^ Hi-otllod katkmg CMtgk k ntpcdally 
camaKm in bidfjidtt tubcrculotl*. but may ocfur In chronic otAnfi of 
the upp^r air pftimfp« 

Vvioiu Xjp9t,—B4r^m( txmgk ;f not ncurelic. b usually uac- 
daied viih iofiammAticiD of the ^otlii, a Wf/TUi fovjA with idvancH 
lubcnulrulx ami firr^Mif. nffij/JK <m brta^n (*>^£h nitb mrdiatlinol 
prtiHun; frvnt whLiie««r cauap. The author boa obf«tved as good ex- 
ampJn in niJUtJve |«ricardlttl effuitbn m fmm h« o^mmoner olum. 





oncutUM- tm tm^ystma thtf ccFURh U pccvUu %a6 wtaaemhti chanc- 
Ivr^tc ia il^r iirolim^tioa of ihc IniJlridual cipiraiioiiA nx\d the nvtl^ 
fc«t forciof^ 4fi(l proUof^K o1 ihc Kiii^ The Acurs^ Ci>w(b of cruup 
ic ft«I| hiMVD tni) li Htfftfilar o^jA rrifly ocnir fit rtriAfn fi^rm« nf 
RLacik puilyss or & ^neUtr t^ugk in icminnJ nar^ uf pulmon&iy 

Tbe ^ jifrdAv/ njltv/ nuy IgUoV varitiWi Furms of phUDiyimol ct>u^ ' \\hnqnnB. 
but it ocoabfuJ uid anu*ual, whcnu in whcMz^ping txm^h when tfcvcl- 
ofwl it if pmbimi uikJ |irai1ic»lly iMthognomLwii:. Finally, |he «b- , 
3^mf tr fCTWlMi «/ cav^ v»A /vr«>flMi;( fhyti<al len^ m«y inrltcalc 
ppofioUDd t6Kmi!ft« «Tmsiv« wrakn^M or ippmirhing rl«aih 4nJ ii 
seco esprcUlly in faUl pncumoniiu of infancy, childhood and old iigr. 

iJMBmd m^vHftfijry ^fifrvnoH nomiaLLy ocntn in t^ a[HO» and 
vpptr inlvrooaUl «{ace» dunng coukIj- The ccinditicm b cnjeiEpmvil | 
in conplijvrvnft &ad fiimJnUted in inliLtratlon. 

SJ*U!'UM.— The tpuiiim jHtii^r u UehI wnnliin of [hr air |iii!NUg(rB 
tibtMncd b^ "hivting'* or oovsbi&s ni^d ^^^ include naaxU phAJvn- 
l^itL brfngeftl, bfondiitl alveolu, and ■ certain amount of oral wn^- 
lion. Alt Mvc ihat rcfocvenlMK pw pu« or 1i1oo<l U iniiouid in cvii- 
■Ut«r<fi «ri(-[ iM ^tfnd lerm rmbracr* ^1 simLUr in&KnaJ flcrivfd 
fricn fuiiJTUS tmniuijiiiuilimi aiih idJAccEil sLtutlurn, or ilQitUEtirc 
pfDOflBCs villnn Uw nBpiniloi7 tnctn Lc- perfonllnf; tbtooA vduno- 
cooFVB qrAL aivftiei.*lc- One mwff obitrw (a). lUaaiatk (b). Ca/or 
^ai tr^ntpvtncy. (c). ^ircvnlml. (d). C«uMifnc& (c). >4miWKl. (Oh 
O^r. (^. JiftwWitUMinM. i}:^), MicfM€apk pHdinfit. Tite reftctlos 
b jdkalinc aitr ftftcr oaiK&i doconipoedljuu inXiCcaaM ovicide rlic Ixxty. 
Jftrftf /r«n niiilnJrf^ Hmtt dtriv^ from favd t* mrdirtruv tb« CoLor 
Tuics fmm ike odoclm nmcoid or nrraun spulum io ihai of pum IjIckkI 
Slij^ purakfti odmutufc (mucepntuifnt sfiiitum) or prc^lominAnoc 
of pM (fmtdtiti) produm varioos Aeg^vf*. of yrllow or jcr«^Uh yrlLnw. 
Dta$ tfnj JMf Inhaktion p^'^ * ding^ or |[nyi«h lim And ]n\t: [liuncnt 
or thi ^fTplopmfnt of «nxin ip-rnu mty finxlt^rr m fniai r»T rvm vivid 
given. Bhtrd uuiy be pure uf icijrorutcd oril> by faitii pinV. li|;;ht 
brown or nlcun ocdor, ira* rust thnding. laicu yellows and gn<nflorth« 
ibin irroiA ^xalkd ''prune jnke" sputum. Tnic Uferk .tpulum Ap{,pnt^ 
only when aOimI jawtdko or peHcr^tinf; hcpckik ii^>acc$a u ptcAcrit 
Ihoujtb mftry Mood ocolafekiiig iperimrnt rf umiciinl linr mci lo thr 
lot fur bile pigment GncpUhtiaucruiy uii^biiiuArviciotu&.fblunimB 
Mid vuiou« other rnndiiion*. *tid vulous o<rufiftti<rntJ iputa sxv ta- ' 
tottDtoeil jk» in i&irTOr juUB^im. uiiUnc dye wurifn ood uthen. In^ 






HjAsst of the miSnil \>iitv vnih hrvwn spuJam pcculur pjgraent **"^ft*f 
celU are pnvnl; in Iht? (irrfivraHrtg »b«o«A ol amcehic dytmbty the 
"an/JkA/y iauit'* ifn^um nui^y be rncounUrcd. and in hj^ctia tbrc h 
occ&iLOft.iily A vixid ot jd^y Like iipiilUTii tuaJy Uke tnnh*d r^tf^' 
fin, «Mrh rtity crfAic nniich unnwBawn' ahmi. 

Air Cont«nt. FottiDincM uid lovt aprdHc j^rily* Bitficate the ak 
content anrl nil i^rtmi t^uTwrn U fTf^hy. Cavicy iptilt apfenr ia 
water u glubulu. fblicniiu^ Ur com like botlica (nvffiffvWar i f n i wi^ u 
Ibcy oak to the bottom, ind in grncral, (j^^ ^mftr TMt pH$ oitknt At 
'inr iha (dr. An J JA« jfHiiUrr tk^ Jnhts t^J erigiit ilir pntin Ikfoir t4m' 
fflrl. Ill bfon^wtajM and jC'i'V'i' <"■' A^ ''^'^ diitind UjtfS 
becauw of ifi*" valuing »prdflr gravliy 

CombCencQ.— A |>iripcr bach^joiind u Kbdlly obt«InciJ by Uyitt% 
A piece of ^ftAt or 1 Pptri *Iish ot'pr bluclc pjipcr or dotfa oir purchj*' 
Ing or mtkiniL a v^jcdftl pUtc uiiL half lL% itur- 
' fuoe fmfc block. One miy ^nd (a). "Ciiv?<J»- 

*yi'»I» I HMim't jfirofj/' tt!iHi arc ntrf ;i>ihtignijJTHJnic 
ol ASlfinm, but moet frf^ui^ni in ihM dibouo. 
They are rrfr^ctDc ind viiiblt to ihc naked ey*. 
rcpicscni A bivnchkflitic «xudAliun (Suhli), am 
inmwliiii!. bui hAv« do i^m ftU^niouEic import- 
ahop. "fliJindt} P^'*" «iT >rlk)wufli white 
Ajkd miubtfd wfKl tiocil, JdW jmrUiRx ^^Stf?^' 
tb>n« of fntty idil cr)^r;i]« and kirirrii doArly 
icaKobUnjc die lorisilUr plu^ ■>{ CdUicuIat lonnUltit utd tiK foiixid ia 
d«coinpo8liloa psioocsBvi (pjlmonAry pinjCNm, fMil c&trHiM, <Cci>* 

M^iicUh JfisfauJmf AvJ partida mre usually »lanliy and vliikt a blue oolar 
with Lv^r^ loluiion. FiMH m^tu tJt whiu and ntrwnrJy imadoiu 
And art icdcUreJ dcam aud bulkier b>- t!it aJditiun of aoedc mW, 

l^britfi. Ilicy VAiy in sim from the tinic^l pJti^ lo the ^brin^rui cnaU <rf the 

ibrondiEal nibe« (cnmpims pnifumat^in, fibhnoei bronchtlia). or the 
diphtbertic membrane, Tht jCbruouj osU sliim beat if aliaken up 
in vnJier. R\n\y And especially In old cum of tebffrcukms. taUow&tts 
fAngt nftm of tunuiJiniblc AtK ait eApnlomDeii* oi varioui forrign 
hodicji of rrc^t <-» ancittil introduclfon mtiy apprnr, i'lH CDnioiC or 
Sfmm rlrti^nniiia ihe fluldiiy and rtm^iis and fiiHMii (rmnpnun pnrii- 
uonU) the nacldity and tci^adty of Ihc spuUun All »>rU oS ttib^ 

*ln A lav <l«-rvnj hivietirne a||(i a Urjcc lunif Hlunr wMrjrrlrd a/lerit 

alnite^l iitiil ^M^kmi^ifihioKvebun-aAQOuiTtDpinniof the old dLatA«r 
. been jTUini/oi for over so "eAm 

^ Fit II -(.'wltiMn'* 

MlBiSES or tOE tOOhACIC VDOElu— ^TCttm, 


nanott may tx tonahoed by Ihtubuft communfcAtlon wfTh Atuccnv. 
ednnoooccut cT*ts> «<ci, ftc 

AllKHUlt>— Wha]r\«r poisnrlrilit 94bounspiilijni shcJkil'lbf obtain^ 
■ftd the tmuputoi vpuiun^ cupct irt Lti bt^Lia- ih^tn ihc mcUilIic and n»ic«i*>. 
paper ciip« %o nnenity uccd- £ar^^ ata^ nf inflAmmatJiiri yic'd 

procHKa Ihouf^ in |>ubnciii&ry nvlty find ofwddl^ hronchfecUsi* 
lofi^ amncnts may be rafiwil at IrrrguLu- limn, oHm wbfn usutniog t 
sfkedtl peatun. Adwiccd pulmanaiy tuberculonx brE>nchofTbcH| 
bronchJMiMii prrformtinK «bcc«»a. pnUn^miry tdmu and rMi^lvlng 
pneumonia [urn tih Utge ainnuDU- 

Odor.— Ordinarily odorLMKvticfi ia9l nturd It nnay \v. f^nl tn ftn^ 
pmoM atlcnilcd willi ticcuiaiMvitiun wiUim ihc Iuiik (brurjcJiJci:liuitt. 
<VlUiB Inbrmilous cBVJtifi^ at0CiB» of litvr. tommunicaling rmpy- 
rim^ inJ rhinidrTuilcally to in gin^nr. 

AlbttMitP ConteBt.— Tbc dbumia ormUitl conilitutTa n muRh 
fliMttUfc of ihr ^evenly ot mn InflanunMicifi hrnce lofnf dtj^r vnluc- 
oiAj be BlittdiH lu A JcLjiJciJ pcrtmtagc aa tli^crculUliiJiE sliiiplr 
bninch£tis Irooi pubnonAry tubrroaltw*.* 

UiCMMc^c FiiidiagB.— Th^ vpuiuiTi ^^DlL|ll Urd br vxaminrd u ;i 
dfti pfqMiBlkm without suiainir tuid tb??n by irakinic a smcOTH drying 
blbe nFruid oilnfcigfbr ibrrcmlmil^inilh Wrijcht'jiXatn, fhnrotiithly 
wuhcdL aad xnountcd. Oov nuf fiad U). /^ai ^jt^frirfif t^Ut tr^im ihe 

noutb Wd pbtfyrUC- (h). Citittmrnar tHi/iUd ciUj Imm thr Iai^tii. 
Inidxa wd brandiL (cV if^mii ^ pd-pnttUtir mini <elh (3$-SQ y-) 
[focntliealreoliwhicfcniaycAnlun (t)^ im^uiaviiigkiyrffradtttmsiica 
of myelin v^inritig EDOcrniiir: Uycrv. (9)^ fi^sdff pigmittt bearing (boiit 
d£vue)edb. (j>. fftmolMin trytiati. U)- ^'^J- (5^ Cj>-W (d) Frc* 
mydin bidia. <c>- KkJific /IbffS- Thnv If pmeni mny b^* found 
by pnMGiJC a daccsr. j^nniJir vr lEuck |>urtion (if »['Uuri licLwrcn 
two l^Mi tlidoi ftnd TUing n low j>nu^«r li-ns^t 'Ihcy iniljcni^ fecrvd 
ileslructko of lung tiaauc oxal frequently oritttnccd 1ubcrcii1oai». tnd 
■nuUy ftbov tbe ttWcdar Amnfgemeni, Slaininft b quit^ unncceMuy. 
ibc only dliCrutiy bda£ ibe paidbTe derivnikin of Ehr t'lbrrs from reinbied 

• To l9« ofNiMm lor aUmmfn SahiJ pmenli W«jpirr'» m^iliAd* vie. h- 
Thai wIi^ jq4 acelk add und ibakc iTiLrnrti)(Vy to prE<ipLialc mijcU, 
filter* ««th, trvat Atmtr irilb NaOll raiiiE npiriy nruinrufH ^nrl im lor 
Albuafn by h^At, paVMStuni l«nwyitnM<^ nr tLibwh't m^Tho^. I 

1 BoUni rf)«d pari* of »pt7lucn anif to^ >Jk O H or K[~>H. wiiinit »»hle 
for M bri«n and Ckh exunlain^ -KlHifd ponioiu i^C \hc \iitK\p\tiit b 4 1 
ViM demr and »«»i;b fa ■Hduii «iKin*Jbl viibuut it> \ 










food in spednuQA nol propi^y sJefpi&rdcd id ooUoclxni. Owini; to 
he prntnrr of i perulinr fn"tnrnf Utry arr optn ahsfni tn pwim^Mort 

Afiutum nnd ncutropihtlo m all tpulL They may show pluKocyik 
1 iiiiJujuiidA u( Uu Ldjlniu m bcruaUiidiu. 'k). £r>fAr4<>iM, MicTT>' 
i flcof^c blood otiBU in moct Bpuu u*ociai«*l with tough «l txkf mvtH 
ck'gTrr. buT triaiTmcufiirdlly ii it firrvfii tmly in Tnlrni pan^xyifiuE 
cough. a<^d<^coU3 hcfnf>nt4jcc *rid ttMc bflomniatiDry or itccroiic proc- 
DMA- Fihrin tf prHmi m«r be demotutiwed by WVi|C(^n*£ method. 
(G)- Cryjluii- The rhi>mbciI(iii]crir»1ab<if<b6kstaiAindu'«ic cmpbr- 
fumt or lung abaccM, kcljjom phthUb. Tho thup il*fiilcT fjadciiUiMl 
Tally Ailtl iryBUil) BUKK<?)t |^ii>:nrnc or advanciiJ lulirn^ul^qi^ while ibt 
ordorkn. <Ktabt<^nl Ch&rcol Lcyiiea cryvtab point lo bmDchial ^*t^*i^m 
Vdlatv or bfa«n amoiphouii maun nr rhcniboldal cryfl^ of hcm^' 
toidiri pa intlobWciKicniion and ulceration wilbln the a1v«oli, and Ic^^ 
and lynut^ nrny \>v prMmt Jn rniphjvm^- (h). Aii>£J<Hd, AnoAft 
thoM occ^rrin^ iji aiiutum art; 4iaiKrtlc btuiUi (and il« v^nu]aii>tv 
th0 nne^a o.Qd limiithy bardlil iind thoftc ol pavumoiuft. anthnUn 
iAflumx^ ty|ihoiri gUndcrt. plaftur and irfirmy w wpH m the Fritd 
lander badllus, inlcrac(iccij.i IdraiEcnoiut and nlhen. Tk< Ittlxrt^ 
baditut ii by i%ir Ihf muxt imprtrumt atui /tir ii% itrMmituttitm PMittf 
Citrtjid iwrit ond €Vtn ammai inccnAjfipn niity ^f tintttcry. In moot 
iostanctv it in my to find (he ^rm in the th^iy particles or thicker 
ponlonsofi^icdiDen.butaidlhectiinc&theymUKtbeoblamad by cen- 
trifuftoJumrinn of the s|>t]tuni- 

To Procure a Concerlmipd Sediment-— TAkrnffpuiiiTnorLei«n. 
diatillc'l water (cn t>aitkancUtir Lr^rqx'Ai^^y^hjlclwilinKaFevilrop^of 
sodium hydratf" wiliitviri (ioyv;:.^*l^**i praciiinlly hdrni»gme*)m 111* 
ntuturc may be dirretly ecettifugrd nnd examined— bcit it is mudi 
better to add a frv drops cA a phcnolphthalein ^^luiioti and add iLevtic 
odd drop by dnip, while istirrini;, tltieJI only a fnlni pink mraain^ Tbe 
teaaUJnf* nnlimeitl rnfiy then be cvQtrifiJiiced and emiminud. »ome of \he 
orifinA] ^pjliim hrEng^ miinl nitTi ihr 4r<iimciiT t" v^urr t>rtTer Aisulon 
in the jflainirifi pnKcu. Tht tif^i arc fl/fcn rtudiiy fojtn^ in r^vm 

The ttftin commonly w^A b tlic Ziebl-NccWn (ultimtcd alcoboTK 
' «alotion of fuchiin or itenlijA violet vJded drop by drop to $% solution 

of urbollr Aetd until a »urfaec tihrtn appear*) whfdi ker|» iodc-finltel) 
^ as doca Ctof^lnvBlcy's solution (i j^. fuehain lo 5 c.r. vt lifiuid cnrbolic 

ACid.add 50 c.r of ^ycerine ctining thoTOu^ly and finally uld looce. 


of water]- To vlinunube Ihe Icac nuittnt fmvgma or limothy barillu* 
ihe ifjcdiDCD iluiuki be tiiOTouglily dccafutuaed hy Cjapclcwiky's 
nwthod aad Ebncr'i ^md <bydrcicb]oric ancl f^vis. a.5, wdii chlondc 
4.5. dhf (U"l vitrr TOO, Hi]n)hol coo), or hj rAfiprnSrJTn'fi uiliiiirm which 
ool ocJr ilccoknica ihc smoKniA btdllua bul BtsiTiH ii blue (nb»riUK 
■loohol iooc.c-^i pri. ronJIrfi+oifihylPAr blu^to nutntfon). Tlif 
BCtuftl proccilm would be (a>- /"Wf^ mi cwttsXif snutU ptrrthn 0) 
N^Ki^ f^iriHM. aj. SpfMJ it. fch Dfj* /AiToujAiy j« I** «>. 
(d), /fMf Uj |ju»in£ ^t rldi1)CTji:cly 1>u1 ticadti) thmufh .il^uhul cjf «nuill 
buAMc SlunclromC) In S timet. («], ^Aitfi with Ihc fuchniD dtbtrbyhold^ 
Ing ihr Kaln-ci>vrTnl r^tvnlljk mrr 8 Ustmt^inr ihirr mfniiLffior plni^ln^ 
it moT ink down upon the auHacc of 1 Petri iliah containinK stain and 
hftttiBf 99 bdling point (vlttm uid tiling of inul] buL>.ilr«l (or urnc 
pcnod, (0- /Vvr (»;f ijv «td «ii e^nUin ikwUrmtHf ^oiMimiv tcpcaC' 
jog »fld blowly dminins il off five or »u timet, (ji)- Wash ifuffcntuhly. 
(h). Uevni iH Wum. Tbc E>]fl» dlrr-^i d^volc'riiuitlun mttbixl of 
Ctbbdt it cotner *nd Iftr;ihc4 (lie rith ol decnlc^rizinK « <eiiun 
nvmbcT of ibc tubnclv b*cil)i. rfo grnalrrf paHmt« %t rrtptirfd tn 

fimSmg. Wkfftftr thtrr it me gtmt mort (an -Jmi muil ^ff }otind and 
Derribic vbUkcA Iwc rctuLwd it\tii\ liuly oiiicIuiuiilih (Fuiu^^b (jtf Icu 
dMdIr Ihui Ihe 100 coouDon Uibrt ti> rind ibc ucnr when i-n«cni- 



Thii mndirm specialty hu ibv aclvamigii^ of pmnitljng praclicnlly 
aM duignnacA to be m^dc at u^t tbri>UKb Ibc uk i^f »prcinl Appliance* 
lor ihii purpovr, "like luyni and ponL-naud tpaoc are reitdily bmughr 
kM> ricw by llic Uftc o{ liKbt itGci.Ux] bj 1 Luoiairc niitrTri u|>vn tbc ! 
nrUct ol A BauH plain mjiror whkh rrc* ivra the inkaKv vf the Blrudure I 
ID bt limUipM^ . Thr various forms ol ]uiyn^oaci>[ie« anr too Incniliar i^tjtig^ 
to tKcd dcMflcd docription. , '™**' 

Tectml^ue.— Tbe ctfcniblt an (•), JItcm;. 4«r<;^y 'i^A' and a good E«»twlL 
ft^ttUtf. (b)' tfuperlj httiitj iufynj^oK^fi^ and rhtintsMpk mim'ri. 
(c), jl fluJy kamd and Ihor^j^k km^id^ i>J Ikt attakmy c} tkt farlt. 

TIh; Uinic baudlvd niiiturs i:r brld tu tht pcii puiuii<?D and iu tlir rcchnHiur- 
caac od tbt lannu afr Lniroducct^ withoui loiichLQH any Airu<turc vntU 
Ifary pmt hark tfic <nft paUir. Thr totiRuc 11 gnu^ted in a diy nftpkin 
between the inda ^nj^r and t}iun)b of ihc uiJO<cupicd hand ^nd held 
Arvdy fonmvL Tbc fndrc finficr Klionld nsi ^izdnKi tbe lowf-r i»th 
tooninf n Mippfl ^ ttcadj the hand and ^ccvcnl yauAv^ v^cavoA^^. 


uiDiCAi mAC>2(«f«. 


upon the mirill&ii fi|kb£ V Ihr mJntv Iw >iead% far^ nl the upper 
ao|^e an txtUent fkw ol 1h« Ur^^i is obc&in^. (h« upp«r pcrtiou ol 
ihc imaf^ nrpnaoiElng anTciiOT, llir lowr poairHnr ttruciitnA. T>«p 
frrvoJi^tiif acd vMfs ^mfvd^ji rortal tbc action of tli« vocd cori& 
In thn extuninalioQ the a^Uchmi^t of tbc hojicllc to thr nurror « ahow; 
tn examin in g Ike nait<-fiharvit.-i j ximllrj iiiiiror U uvil uid lAtiodiKed 
v«U back lo the poficrior phcirvDi^eftl wall, ihc free cdnc oJ the mirror 
bdnf uptumi If thv psx\rti\ bj <lrfp brr&tJiing ami {lauit^j- on 
maintaun a Telajcod soft pelalt the ports may be Bran n^lhout diffioUtr» 
but ofimlimet si>nie onr of ^e ip^al forms of the palnle rrTracton 
mul be utci to pull l)ial sliucluir hroilj fonrAfd and ili^pily jpwanL 
litniaiuy. JumUiKg and trfnor on the pftft of the examiner imrMaUx 
CftUK mdiini^;, &nil uttiiaiun^) Vl^'x^^I^* fo^y ben Durked sa 
to naoawrlaiw the ptttimiMry iiclnintiatrttlJon ol i bromi4» or tht ve 
of & dilute solution of co^Line The smatt mirror jkmtU NifarJiaWy 
^ fln;i(»Mtfy tteait. uyifmtd h pmrml nis»m^. and takd /«r (UPMsmtt 
ftflol ty laying its bmt agmnsr tkf f*#b pJ Iki handi. The pailcni'a 
head ihoM ht ^li^tly lUtcJ bad&v&ril tu brai &liuw lire lar^m juid 
heltf p«Tpandkubr or bidiiMd forwutl in aumiaing the nuo-phai^nkj. 
The aiiLc^dcT tuna] duunber is examined by direa U^e. the palieni'a 
hoad being tilini bacbvird and the abe dmim cutwarcb by mcAita of 
a pmbp or one of ihe varbuK na«l dllaiom brflngtng Into view the 
vcalJbulc, »cpiun)i iofrriui mcatti^ irJerior tud>inatB. midAe faealua 
and nalddTo luibhaEe. Obattuciing arcrttion fa spnLfvd or wfp^ 
iwa> ami oonto^)t!t>n a rriidiif rtduaed by coouni* or supmenAliit. 

DISEASES OF THE NOSE,— Acute Coryia [acuie rhiniib),--A 
ilrMtiptmcfcbUunlvermtly known ailment kunnecflKanr. TTir*ii*<rp- 
libiliiy of an indlvMuaJ la maricrlly incrr^kacii by the exUt«ncc of a 
chronic cfttnrrhiJ SnUanunatlwi of the naaaJ pWijpa^ czhauackm. 
chronic dbcaacv an<l bwcTcd riulity from whatever cause. The 
mucous membmne in sucb csam sboir« primorOy. ccngtslion. iwflling 
«iid dimmUhcd sc^irtiont sccoadaHly, the dumrleriatk pmfatc roucn- 
puxulcnt discluu]^^ 

ChTonic Rtaiiillla (rhmnir ratarrh). — Rf^ulrlng fmm rrpmifd 
acute ailacka or due io general impftUTncnt of cutridon. prrscnb much 
thr Hmr appruancM as acul« rhinitis- 

Hyp«nropbic Miiiutu.— Uy dironic ratirrhal inflnmnutjon ibe 
vascxUar lurbinate ti(«iw« become pcrma^iently dintcfidcd and the 
epithelial layd i]itckcne<l tun\ lafilinicd. This onvlltltm h frrqumtly 
Mtod*tcd with cxoatoan or ecebondroaca of the na»nl Kpium ft^d U 

ntuuM our tbs MOge. 

BuAcd M t^ ftaUrior utd pottetior ponlnns oi ihc middle 
loifalAicc- The tyiD^MoiW are cbidly chotr of chronic ntul obsiruction 
Attd caUiiti. ttliiLli Icul lu oiuuth bicdiliLrifE «ud fnxjuuit m:jli; or 
•ubacutr iiladc» Therr b a iroublnomtr recumflt obtiructjon 
ciijcdaltj maitol b nrumbcdcy, vtch jMiliena awAkEng in ifac mumlng 
wiih drr lipo^ coAlod toacitc and oft«iitimc4 fcul l>r<alh, TKc dralnocc 
of imriLon U Imfffrred «atb anil ru<r c«ai;c dbs^rurrlon of ihr noul 
diKi; ttc Kma u( tmdL U3IC uid Intfiag iiuy be m&rkcdlj oflcOcid. 
end thv Eu«4ch^ 1ub« nuy be th« wt^\ oi a c^iuthal precev. 
Huibcbcs *xt wmmon chhu u Cbe rouli af inftindibukr (Kduibri 
<a actual dbcut oE tb« gonial ainua, 

Til Mi. MM uid EccbondroBU.— Thnt fnmialianK an rmofrnE^cd 
■A l4f^l and Uidr conjiilBnCfl ddcimlnod by Ihc mc of ibc probc^ 

StfUl DtvlallMU-— Thbcondhion, rard; tbuint in riigtit clcgnv. Ea 
palbolopc unlr wLcd it produces prcnurc or aJjoulutti oteUvclton. 
Mufccd densAioiDi Uckin^ a huloryof irauinatUm trt lUitally aModatecl 
widi a Hgb arrhed polalc and pnnbablj «ith prc^buitty uisiljif^ JKlcnoid 
icnyirdi*«f liie itaw-pharyiuL They mair be partial or tjcucr^. anpilar 
nr AtrvMl. are mrlily TrrogTYlfcd tifton fx&minaUon and ustinJy aMa- 
dalc<l with chronk <alarriu 

Saplal B«matOQu.— CtuaUj the f«9ult 4>t «a injiuy. it u nropiiaod 
as a bkud red lontar. 

SapUl Abtcwa.— ]£ a frcqucctl ac^nc of tcpla] perforatioo aod 
fonn* a iurf uailnjjc nrcQing' 

Atro^c Rbi&itU t4ry caUnti). ThU [4 usually « foqucQCC of 
dbrank hypvitrofibjc rhlnirh xml in rhara^irrl^rd by fi-nil brraih and a ', fbtA 
diy gbacd nuicoiai membrane tarrying ioxnly ami foul sccrotiona 
wliidi tb]r inio adhemU and o0<iuivf icaba arrl icoIm. Not in&e* 
qoeiMly. these k ukcfadoa at iuider]>iag liaiuca and In bnff ^landing 
rnri_ aduai sinictuni aimpby, iIjc lurbinalt bciDc* bdng nhmnkea 
aad the Mprum ibin.* In ddlcsu chlklivn the conditJdn rnay oxvlsi 
with a thin watery cxo^rtly fetid accretion (vjucaa^ 

IfMrMlaf ElhmoldiHa.—At a rvwhoi hitlflmma[i<>rt<jf ihr fTlJci»1le 
tiubinatr^ iHxr^^pH of ihc iixfcric* tuibinilc and other tlbniDidd itnic- 
tuna may oc<ut- PcrioatitU and peemic are uiuully foUowc^ by the 
f%to^AXtaa cd a Umbcd aAUHial of Ixmc Tt^ «ymjibxn» are duAc of a 
■ttppuEBlJw hdamiBalioa cpedaJly involvii^g ibe nuddlfi UirbEnaie. 
PiTsuirilniBtion of ibciqtcuinia conuDun and nasal po1y|)1 frr(|Upntly 

■The oaid dunibm luk catraordJoaHly and ckanciirBtii^lf twAaii 





rcuJt An<l Quy runAin u evidence of p4st dbcwc, The probe intiiD- 
^luctd at ihr tiif of the luppiinuioii uftiullir dclHti th» ocrtolk bone, 

Eajr FvTM' (periodic vasMDotcr cuiTaa).^ Hoatfvcr obwarc ibc 
oitfai fACTon* the di»«ue offen no d^a^ostic diftaUtl««. llw •H"?' 
Eoms arr merely ibox ol an unwually ulntxiul^ or pcnu'.oiily re- 
cuTTtDt kcutc ooT^nuk «4di a fnofiue valoy rather than muco punlenl 
dftdiaigc; comiixfE on ptriodicaltf ohm ai a ctafM day or ivntk io radi 
yt:u and not difr^ucntlir a«»>cUlc>i, allernatlcif with, or fubttilulccl 
hy. nITacki of pUTic brL>nchiAJ Mthnta. 'I^r <]lwa»<' \% moat tttqaHti 
Id llic laid apHii^ idoiiIIjs (rwc ojiil) ofit! in Au^iisI anri Scpli 
(ha/ fever) [inJ [ti sonnr ioAtancn occun irrtgularlv ur iolt^ving 
surb influences as are (laiTil>«l undrr iXk eiditng aijjca of asUima. 
In Cdiain ca*cs a violent huaaoinjc and markeiily paroxyioial cou|{b 
may b* prtacnt, Sll^hi fctrcr mny orcur oc inirrvAU and the uMia) 
JuraEicii [A fr^m i*?Mt Eu ata wcrka. 

SaiAl Polypi.— Tbt'tc nay br eilbfr muoQiiaorhbn>ut. the tonairr 
being Mift and grUiinoim, ihc Uticr banl^ Tbey an nmt [omiDDQ 
in ihc pnflcndr cbnmbcr, nuy cAnac n«eronv inTbde ibc adjacent 
radtlc^ rirr^nn thr rr^r and tn the cvk of Ahrmu j^rowthi inay tircoiinr 

Sarcoma and CarcLnoiTia^— The tairomataareusuaUy^t 
red in wht and aaMKLJuicJ njih ulcrralluti and a|[t?juii« diachuie. 
CananiMnfl U uiuaUy efniheliomalous or cnoepAialoid in type and is 
eicesdvely rare u a (jriiu^iry cli>eaic. 

Ratal SyphUU. — Hrimary le>i(?r.i are nlmiift unknown, aevondary 
Irsionif (Y^inr^ifV vc'tth ihr AikpeaTAn<:c of ihr rvamh^^mata upon oiKtr 
partj. but tcrtiaiy IrsSons appear ta nodular swvUing* on Siiiypart of the 
aote. Bthnnng here aa pb^Mhrre. tbry undergo abaoiptioii or Demaii. 
aiu-nilcil by a foul bicalh and a mpidly dcatmdive necrosu of aU 
EttMMa, N^ metre icrriMe pteture is preunlcd ifaan that of rapidJy 
pmj;rtsifTt aypliilitk nrcrcrtk tnvuMnf; ilie nasjl tinitttirirM, 

EpistazLf . —Nasat ktmorth^t' ^tam tfUffy a* a rtmdi «/ £t«ai«M 
phytUitt *irt4 mrnf^rJ rxtrtiftn. itfuria. Bpftmims, trationt. nfllr^raPbMU, 
tttmuri aifccting tlie nu»l mucous nvmbflLnr, vrnmtt ohstrmtHtm as in 
tumon of tbc ikmni and mediaaiunun and tn mitrot ami ihoisfU 
dixan or hi^ arttrud prttinn aaictiated u4tlt UJI vtMirictilar kyp<9* 
tntphy or arkrif tcltrans. Nuol oaAffcadon alone or as a part of a 
ornbrml oortgeaifrjTi f^ivea riw to «|ji|^e or repealed ^M-rnoirhagea aad \\ 
ocdua aa a prodjonal ^mptom of acuie infoctfioua dliaaan. eapedally 
tjphdd. and U a oomplicarion of profound cljicraAfumc^aa leukemia. 

DtSK«SE9 or im rSABYVX. 


lophDia. flcuny ftnd ptirpura, (a whidi {c tnny be IftlaL Rirdr 

It i« A sovrcc of vlctrioui rDcn>iniAtion or hcnuvrbnlH*! t>lcf fl hic* &nd 

II ihniili be rrannnlwrrd thai rrpcalf d hrmorrhagcA ollcri itiflr«gxnUd 

OTOfwrluDLcd LD OLscUltiu^ aiaj^ be liic tuujcc uf a Ljmfmjiid !n.otiii!iry ,^ waneoT 


Fonlfn Bodictt tn the fTfMv. — f n n child or iimnr ji?rwn a muroiil 
diKhaflSt b«cominj£ irtirvlenL or perhaps fetid and bloodr should sufixral 
jl Imc^ h&lv lo the n«r, and ^iomnnfl* a rhlnosmplr naminiiilfin- 

DI8EA8ES OF T&£ PHARYITX. Aiut*, chrtmk ^tfuiiintphk 
^k^ryupiU piT««ni nMAii;Ulv th« bnu- jvmf tr^mH »i <li> limilar h«ion« 
al Uk nA«l mucUM. In Iht^ ftCtiU.' fonn thi- thrmt ik -aitr. iXiH awl dry, 
Tbece b drtpbAgui. boanc«RS oatl in »cvert imtn swctlbf; of Uic 
omrkil iffitmK Ibr pnrlai! U i-nncinii^illy iryrng m ihr thtani 
ttA the KCittiun toidft lu bcoamc vudd juitl tcuACJOUA^ ChTonic 
pbiryngSla pmrniA much ihc asmc fiymplomc dut1ii|; tin prricHl ot 
eacnbaikm and Crc<iMutlr abuw& a »|iTdAl mv.iNcinnir nf ihc follidc!^ 
ShtAiE the throffl a grvitdar ;^p|Xurantc. K'HU'Einm dt-^ribrd &i a 
■qwnif dkrwar. " fnlliculot pharj^K^lin-" Tlir Alfuphic fnrm ihawn 
A thia f|lulcmn|[ mucous mcmt^ranc, tad ihc tbro«t a <iry>nc| j^tiff Anil 
ncay he (Liar<l vhh Hlnnfffl <if MM vrmlnn. Thr naA^-phAryriT 
m^r bt cbidtr in^iilicd hading (u a dry bununi; MnaliiMi and aaai 
troubieaomc and imUtutg vffcau to dtfocEgv •ccirtbn (havrking). 
1o Mulir wndhkrfu the neconibfy lucruic of scotlioo may Ic iirnfuK. 
Tht >mf hie iorm U opcdnllt diagm«ibl«^ in ib» rvAiodt and a hyper- 
tiopUc form may inToWr Ihr Ul^ml walk at ibe phnryiu. 

Poi* fiaail AdcDoids. TKe«e lymphoid «trucrure» jcrcaily alT<vi 
rht hnlth. phycinil jjid mrnut dovtlojmifnt ami fitiurr life i^rrhiMrirn. 
T1>c]r npmcnt hypcrliophicd lymphoid tiasuc and form Tucuhjr 
growtia dther brood batrd or mmHc, nswciffle* mod«niteIy firm and 
Uirnus. Tbcy are aator^iibingly (rctiucai indmay otTccL nrfaoZc facnlKo^ 
Eatauvdy coltl, «i dunp and fha&jptble dimatts s«tm l<> mciakv 
thdr frrqumty and thaiigh ihr n^ndldon mny he ti>r\gfD\i\\ ii i*. wlflnni 
notictaWc until the lkc of two ytAn. TW •ymptoca» cjx varied &nd 
iMtittting. In Ihr tyfdnd and pmnmmrrri c*4e4 the tfhEld h a niomh 
cun Um pofirth it uwally Ivig?^ Smalkr bcdJA may i>rvcnht]cu 
pfoducE morted iniUbiUty, latlcasnas ncd a cumph-tc chanjEt in ihi: 
di^iQWliofiMidaMMalftaivityoflhcdiLld. ImUcaaca there is IncttMcd 
liabdlty to jui^ir (wyTO. rivmp, trifi(J!IJliA. iHi^fij^Ut ami hmnrhhit 
and added doA^r Iron) Attacks of mauJca^ Ku^cl lt^ci> t^Wj^^i^ A^^vm. 







djug^ and <UpJjlbrTfd If UDFrlkvod tlwy na.j onilrTgo MnDphf m 
fcdult life appicscboi uaudly lonuift bdund dim^ luJO-ptMUjninl 
oiiirrb, high ardif*! pdate And & ilefbnncd dwK, Mnuih bmiUnjt 
nuftl vi>kc uid snorinie uid llic rrldcnt inatSAc (>f oUsinidzin in tbr 
domi rrcctnbcni pxiti^m ahotild atXi mtmltm lo thciic caicx lot- 
ptivcd hcuiog i» nliTuifrly lumiuuiL and b due M JnTahrinent of l^ 
EusiAchUn tube. It is moraovcr one of tbe rtiUt fauscA ol 

K», J*,— ^«^*■ ■ ftls^lcflui 

cnumis. night lerora irrth prindiwj?, fnuTn-miiHi^n*! duttiHuncf*. 
cnmp and |K4*Ibl\ r]<il<|<-s m'' ■' 

SjrpbUttlC PhftryDgLii^ ^ -' < h^mfl IS rliffuMor laktt 

llif foim of ft vcvftCd/ rntf Atuuf on lliculcnui pilUra. HfaicticndjabiupOjr 
at the urula- An frccompoRying hiyn^tu U usa^jr pnwni. Mucous 
|kRlc-hG4 if pmctLl (Ftid lo KfTantrtTf but Irrtluy Italan* arr frnjupml) 

RMTQ-phniyn^al Abcten.— Such ib^rfwn an unlUi^nl uid 
via0l oflfn in the vTO'pliiLrrni. bul may be itppgaik cUhcr ihc nuot or 

•I'hc ilHisiticion ihovi b marked cbk prcH^ting&U of Ihif iH'^iCal 
loitifa rnummtf^ ibnv*. Iiui dier ujAmiuii Uktiig <hi a narnul ' 
mrni and (nnM #ifim>ion- 

liiijifKil ponhm ttnd arc Alien 10 be «cn onty «rlih ihe nrirmr- Jftjury 

Vid cvin u( (Ik voubnc ttz the u»uaI cuunn IhtiuKli ihcy ma^ cooi- 

plicsM loadUr ab«CM*. ^rp^Uie M(i luU^r^ m\<w. According 10 ibdr gmmiomt. 

loalko llw7 csiue obttnidnl niUEd l^r^iihin^t Kins(n«l!c dyipti'rA. 

ibofnCBp or dftutus nununn* combined vrith vymptom^ of kvctc 

phnfynf^lt and the WjiI !UiJ ^nrml fiympTnini of afavcst. 

Pftnlysl* and Turoon. rnml^v* a( ilic phuynx need nol \x 
fttpantdy cioniiilcred, ibc lumon of tlils rcgiun mi/ t&k« an; fnnn 
■nd bckvK to twigay^ 

DISEASES Iff THE TORSlLS.-ActJte ToaftiUiiu.-ThU com* 
non dheuc of joung people b nur b uif^nu xad rh*^ cltittlj', fu rda- 
lion CO acute rhcuntnium. cborDL cndooirdilLit and cr^llu^mji noidi:duin a 
riTrrmi^ly visggraitiT. fi prrvilU chlcAy In the tpHng tn thk cnimiry 
ant-l ^ccu botb aeiDca oi|ii&[ly- 

SjPSlptOdB*. — A chill or chillinn«H niuacular and bonr pun «» fol' 
loweil by rnfddty risine fewr. with sorr UiruU and ilyaph«gia: the tcm- 
Ijeraitav v»die> 103-105° f„ oiul Uic voJc« jnny be thick jtm) nasal. , 
Tbr inntlU *n c«-<i||m and ii^fW wich n rrarldy tfdUcAdAiie nudATc. Kiml^r 
*hach m«r bcoocnc c»niueni. but trniU lo be limllcd to (be lonaiL 
TW dnntP laitt bui a f«w I'layt and b uuiatly unccimpliialrri In 
ccftein uMKDCtt the difdUlKric membrane may b? k dojd;' alcnukttd 
aa lo deaaaikd odtnnl ietU. 

SupfttTAtJiv TonaillitiB Iciithtv). — TTlU tlifJtn frum Lbc prtm^ 
i»% h€n cJik^y m il>c ^tf»Jjin«n«iliH^ invAlvemeru ^f ^m: lon^l. noffc 
m'olrnc octM. higher fever and ptilv rate and jpeaii^r fjr»«itr»rion. 
Tbc local ^rmplonu arc thotc of p(iiii> dyBffbft|;ui and oiuikcd ^wcUing , 
of ^k the umiQ as^l tfcr |)CTilonaillir Ibmiea Thp (vrvicHiJ glands 1 
■/e enkrfed. Ndliaty sct^ntioa ia iocrra^tcd and widim two or Ihrcc 
dayi ddccuatiDci ii eridccil and tbimiRh rupture or by Ihc luc ol thaj 
kniie Lbe dlicijc paiaca B«>tli IlhuIU m«y be bvulvcd. ibc pus [ita(««>- 
nuy burro* wtifc unccpecied npJdiiy. and c^lcma of llie ^otln 
may occur. Qmrniy *lumIH tM A* nUwivi it f^n im ;.' k^hiJiw/twh 

Chrooic loiUiUUtla.^Chranic hyperlrophy often oanKiatcd mih 
■JeoK AidlKMinj. like nUD-i^aryafCftl idcnclds u do«dy onodatcd 
10 iiMstkd lyrapbalim utd the URiLilicftnu &nd ctTect ol Uw two 
Mooa b ttKQibJly the aamc (sn- flcknL>id»). 

DISEASES OP THE LARYNX- Simpl*. acute And subactJta 
larynghia an 100 wril known to nixt\ ritefidnJ ik'n-riptirm. ifirir chief , tornmtvi 
cbmcieriitki beinf lun^dcgiOAofbouvcnca. p&lniuV ^n^ ^ocura^ >wvtii 



im>3CAL DtAOtQSBk 



ntfA tt till 11- 

tPgcotigb.giXMfml oocigstion of the mucoui men^rvie »nd vool <nrdt- 
Vid scant viidiJ McntioiL 

Cbrooic luynsitis k ft cjommon <omplkmtioft of othf <ii Maw >o( 
[hr rraplrniory intrl nnrl s vrry fnYtu^ nr f^inn of jaitj^ nmtittii saA 
u b cjEpcHcnocil b)^ BSoKcn* auctioaccn. budoUcSi anay oficcra and 
Olfavtt, In ks milder forrn* ll is ftttodtatd irilh Tfjf «xccviw anoking 
of tobftoco* oveniK of alcoholicvv i^td thf rhrunutllc or souu dUtLc«Et. 
It 11 panicakily Irequcat in ^ poodj^ nouruhcd pavant. »pcdajlly 
wch u live or work in diuLv. Hauuv or ritifticd aiinoaphem, Ckronic 
Of PDCumnt hoATicncsi of wrmK <i<^7cr. sonty tctttdoua Kattion, 
lixsl itn'tnlion. liT^rigraJ cungntiiHi And mtirr or ln& oough an ibr 
chief tfpapLom^ 'Hic irocal oiniB uc somttima miiffbctcd and even 
whiter than Donnil though onasEonalljr Ihcir HMvemenl u frsthcCcd 
by 9weWlti% g| adjaoeiit stnicturva. The cmijch nuf be paroAjniuil n 
vioUni and prajoctilc, tiie dried iccretioQ ictitifc blw a (on^SQ bodj. 
A form prcrUrty tiraHar ta <arophU rblnJi^ juid ^riiuyn^lb aajr octvr 

Edtma of Um GlottU, -Cases ol auddcta enact aad nptd^ &ta1 
lennJuniioii may ixrur but usually \i bprvcedod by progiecciveiiupfas- 
(Oif> dTtpcnea with hoarKnco or a{kho[ua. The laiyiixut^upc ur nrti 
the linger al onre rcveaU il and do condiuon more ufgjrnlly d«ciuicuk 
jjTOiTipi. ufini liiiumilalc. &nil mcIkaJ ircatiucut. Il almuld be mneni- 
bend that thb condition nay oofQpb<atc actual traiimatuini capcoally 
bumi. or ihr Inhatitloti of potoonourt and irntaiirig gun. (b« Infpivilort 
iif cormtivc poboiu, diphtheria, ery^ipt-liuv quinnvt sicaHcI fever, tyirh 
Brf^fl <tjfir-ase. f^hltis, tubcrciitnib and dLabclft mdliiufl. Ii ii 
rate In aiaudaLkni with t^iiijieiy ocule Uiyn>iJLk 

Croup.— lliLs well nigh muvcful ailment f%\ diildreiD occun bet 
tlte *^ of ut munthsi and llute years, ranrly later, anil 'i^ tmdoubtcdiy 
A fiurrlv reflex condition, ncfc^ls, lh(^ irritniion of t^hin^o Lifffc tomiT* 
and adcnuid fcr^mhs helrg the chief lacton The lymptomt >f» thoar 
of B[3M[nodic inAfilnloey dyiptuca. Il » preceded by « diaractai»tk 
hoan»r. bruen, hoUow eouj^, aeenmf>Arfed by martEVd hoancntw 
and during the apaoni the dilM u ijAuvik and a&pliyjLiBliun may weni 
imminent- The peculiar crowing »C'Und attvadbi; the forced indrait 
of A^r ihrni^t^ rhr ^duIc dunk b dittraitediitk of the Uiveancnnd fafniUar 
to both ph>iEdAO and laymut. Jo many c^sa the ftttKka kat only 
fur a fhriTT lime, usually coming on about mldolghc la othtn they 
mAy iccui un Kvrral »iece»riv nij^hl^ and the cbnd b lioarae and hu 
a croupy cou^h Coo vnliionft rwJy <Ketir and tkaib during the altadu 
■ almtot tmkuuvii. laqngajmu ifridMbw b a icnnn pplied to an 


Pnt^gfg Ot tSfi BWWCVI. LUVftS AM> PUCTtA. 


sddudDT T&tynietal ipMs vilclt mar ^ ^t^cf noeiumd or tfinnuJ 
wlbdEftthPhfMntBni and cough AfciDup^ ltcoTrt«pondjto"pAHkro 
fiu" "diLtilciuwkDt'/' "I>u]<lir^tli<t}icall]" uf lh« Uk^aiLL] convulaons, 
cvp^'pcddl or general* may occur. 

Tnw Craiip ffnanbnjwu* croup), — tn are in&iviCB opcrruilly 
lli awMki aad patvms thia Tcmlilc dj»ciuie u anauodAlc^! wilh dl^h- 
Ibtrta. M cvrilAirily toy fjrmaniE Uryngr^ «ictuuU imAfi«i« « fliph- 
thedcic membrane vul dvro&ntib |»rompt in(ubaiioT) And Urjcc ijoocs of 
dipfaiheni aabLuuD. 

fijrpbUttic Laryn^tio-'Thu b orduiiirLlv « tertiary Ir^n und mn> 
oceut iTo or thm doc*de« afur tlie prunury mf^ctioD, Tlir te<ii£dAr> 
«i|P mmy howmr ^ve rise lo hyiirr^cmlcu Rymmrlricnl ukmrlnn 
uid cw>dylom>t» wMch mft^ Racdvc of ulcenilc. The leunma mur 
cant dwp tikeniion or fwcmii with rrmihbg «i«noeS4 fmm ci<^:iiroxl 
conlndion. The iJicnpctilic laM b often n^cctBuy- Cunseniul 
tajya^al f^philu uiually 3i|jp<art m inEancy, more rarely at the age od 
fdberty (bemtiLuU Larilal 

Txibcrevloua LtLrriicttU. PrmiAry fuhttrLiUniv in xhj^ tmtan b 
rivrTfr-Hy luv uul tntmlly ihmi^ nr^t ^Iwnyt th<- Irciinn indi^iri &n 
^dvontfd pubnonary Icaion.* The tymptonu nrt ibooe of e penbtent 
dmmic kiynplb; hf^Mnin— i or aphonia being a marked and eariy 
ffmpUMKL ukd nrdcnring puaful if Ulcic U epigloitic or plutrynsnil 
rnioQ, The kcyngcal muoom membrsui? b ii tint ^/i- (Ln<t Inter 
uky gray, Uu aryirmMs jAov a pyrifwm yutrliing nvtii Ihr <pi- 
xM£f is JwidA ihtfftd, 7Ae «kfri iWmnVt^ df« sMSrw ind brp*ni 
wUk gf^y kiVT ami trrtgwiar otOUmrt. atttt iA/ v/val fttrdi tiru/Ttly 
cffMf "mM *9km'* jron uif^atm. The lubertlc badllya con u*U' 
ally be drtnonttalvd euQy and makrt ihe diagn«ii poiiirvc. 

TuEOOrs of the Ltijiuu— Tbe gencrai %jm[>1i»mfi uf lar^n^al 
tucnon are dyvphooii and aphonia, iniermitivni or pcriiA«nt djspntxa. 
oougb, and »metlnica laryngeal Kpum. Censin ^wtlia a1)ii^<^ xhv 
cor^ are tubjcctwdj^ ^jnnpConkM and icmc «cnllc (^revirih* pioduoc 
ftfftin^ iniermfltPnr and CnrguUr §ymj}Ujnn viTli n'nlenT p&roi)'nnaI 
ooufh and are cjun difficoll to arc witb ihc lan'n^Kopc- 



olotpc facion arc ontjIUlUv the »iuc m oil fotins vrf timijlc brondikb 

*N««rly mil td the mippotttily prlnaiy <um prorr lo Kc pcrandary t« 
•dvaMcd b4l Ulvni orjwrtiaUy wrccttd futri^onary lM«mi 'J*hcy *U1 bc- 
nOI mar a* th* X-Kay U taott gmvrally tued m dia^vovia. 

f nrrii- 


( Aivh, 


A dk«Dgeal>l«; <lcjnp cbcuie. wbctber lanpefKte or Uopk, i% ft poteol 
futor and ^EMZml low tIu^iiv i(i\ii» J:. Cbronlc gout nlmtinfai 
Bri^t'ft difcuc SAcompenuicil mJtnJ lc«iuk» «Bd oBAJ&ria ptfdiqjMe to 
it umI il [itviriably &av^irip«jk!r» tiLbf-rculoei& mpbywrna ukd atthni. 
In ftojte diseue such « mcoalo. irphoid. enuJJpoi. iniueiuB ud 
ttiiooiHOg cough it it & oommon or intftriAbLe complkaltOD, Mftkflftiv 
cblcflf tflct^ted hy rouon of Lltur ktcuct rsponurv ik> (KniAtn tnfli 

, and tlt« dlMflM^of ctloloipc rdalioruhip. and it i« puticuJariy pi 
al iIht ntmnr4 ol life^ Sled grinidciv, tUinc oiticra. iMkcn, ndlctx 

. sbokfrrk Hi worLcxv. Ofid cmpbrM* fat Aiu and ootton nulb sbovf « 
fpeddl tmctmcy 10 l}itt disnw but so f&r as so.itr bronchitis b CMt- 
nracd the comtnoa "c«rya*' ordiiiarny Ihe c;idtirrg hoot, the dlaciur 

' G^ctcndiTiji appQicntly by continuity of iinicturc tnm the upper 10 the 
lowci aU inaufi^ Th« mbulcii u>A foolh&rdy (jrocoa uf "hard- 

' cning" yauA^ infaAU by rvcklcM eipoaurr to hanh wcaihor i$ a poto&l 
Eulor tn thr productiiin of lb« dianw lA infants anil jvmn^ childm, 
and hdp4 f;totly tio mtll infant mortHlity^ 
Morbid Anatomy. — At &nt, In acute broncbiili. the auoouameai- 

' branc* are and UTlIaLtc.WteT there bin uoj'liuitilcntjtfot- 

' lion, tb« BHmbnAM afe a«<ill«n, may b« «d«tEUlou«. and ^hduld the 
Im3mtilul» bcEome a0fi:ted a (lixfcminaled bronchtj-fincumottb 
(capilkry broachilia) nvniu. la duonic hrondulid the bag continued 
mfljirnmAtory dungn l«d to pennanoii thkhenlng or atrnpihy. gia&U' 

; lat^jn or even u]L;cralfon and l1 it one uf the cauMa <4 a fuiifoinn oe 
ncculftr iliUiailnn krvown aa t'ronchiect3»iA, 

The tiyiiiptouiH uf acute broQchUis ore leva, UMaJly modrntr^ 
(99.5*-iojf J.) mbstent-ji fam, i^fnist of opprtaim. hoars^n^M, 
gmffa/«MJiT(V ciTUf ^ dl Gr»t dr>', ringing, hornh and Eomrvhatpabifiif. 
later n^-jiat aMn\ hollow. The spjiQ^. at £nt mucoid and Kant tooo 
beo^mc* nuco-puntLcnt and noroeiimcs jiiuf^U. and If the cou^ ii 
Violent may aha* blood aircftlu. 

Physical Signs.— 1^h» only important phyiiniL ngoi are the 
tMhni und si/norifUi t^Ui uf Hik 6ii3i fta^ lullowrd by ihr miurjiu. 
M6fM£ Of t^tm fitf||Mff rjitf, of the «ia^ of exudation, Slr^hl 
dyiqncni and cyacMtU may he evident, and ^ilpailon niAv rrvM] 
fhonchal fremitua- Marked cy«jio«ia aui^ccsla diMcminiiet] brurcho- 

^imcumnnii. a preexUinii rmphriemai, or a eonipljratinj cardio-vas- 
cuUr Iciion, 
Prognoiil-— It la*t* from a frwdap to »<%'era] wvtkt andon«may 

; ordinarily anildpiLc n prompt and ccunpbtte leooicry aad Cnedom from 

tasEAgn ^vooATD wrni cnsoenc tRONcnms^ 


tdipae m!t In tlxnc peracn:* u^ivied by tAtiecvdcni dbcaseot btd)^ 

of CbronlC BnmchlOa.-'TIiii U rwnl rxlly m sff-rmilnry 
Ibc heFcdi[«7 ckmcnt mftir be tnarkcd^ ii js an inraHablc 
ucoaqMnicnvDl of tfthma^ fncompcnfincd tnftnl dis^jxte or cmphy- 
icnw tod mtay pcnldcnt «uk» ^rc ow^dalfil aiUi chronic ^Umuu 
of the kidiwvH. The diajcrL<«« of "vhronk bronchJtU" tLttei "vrlnlcr 
ecm^" tuve of Utr >r«r« rlJmlithhcd, u eiact mcthoda Nave jintvcn 
isanj. wpcrinLly hi the ^'oun^. to b« coMV of ptailnxinAry tub^mbMisL 
Putrid tnnciiiit u chronic anri chancTccur<t by foul smelling ipuTum. 
bol k^rdly docno & KpoJutc plvrc because of iu almost i^ivdrinbtc 
uAodaika viih bronchiccUjui. ganureQC. and ft ruptured abaceu, or 

P|lj*ie«] Eugna. — U>U««, u to ominaonly ih« cuc» one fto^li vdl 
narfcvid fqnvptontt of mpAtysiaiu. the |)h>'Hii-Al ttfgiu vf lliis armfr^E 
are Ihntled Ic stbiUnt. »onopouK mucous or bubbling fftJce rnOt more or 

In filrlDOtu broachJilft librinc^iua csau arc rcmiicil and expelled;! 
thvH ar* ofl«fl QTlVMiTV and »amvtimM pTu<luc« bnmchial blocking atid \ 
alciectMM> Lif lung ut^u. Dyafrrua ind cough arc murr uigtnt than ia 
ofi&iBiy bfoocbiti« and the «tudu may be sitigle. ivcurmit acute or 
duonic- ]i i> a iHmkat airioHty. 


EUPHTSEBU* — This mny be uufc or (Liudk-, ^ucm] i>r IolaL 
interBlitia] or vmcuki'. ^nd a vcBKubi cmphfsema may hi- dther 
Aliofitiic m bypcrtitiipbJc- A locdbed Empb>iienna mny be lempnmry 
ot pcfOMiicat and u usualky fioaiioud* np«c9caiing ihc dT«€t of ovcr- 
ad'on aiioclifc<d iriili lcin|ionfy or pemnukCfil lorn o4 fundJon En 
potflima of the luap* The bn< najDijlo urc kcii in pulmonuy 
itU^rOitiai MmphyierrM, 'V\m c^m^Iition ifc cawed Irr 
the nifiture of a 3U|ict£d4J or deep air vcaTck whiLlu during rjokEU 
ocnig^ or *lniuuii|t petfiuts iW escape of Ibe air bio the areolar tu&ue* 
akd pmdurcft dtiaer (a) bikMntiar or (b) MtbatiafUflus fnphyitma, 
or even (c) pnfumtAfinx accordios to the ttic %nd dcjcrcc of Iu exien< 
JHO. .SvAcvaaivKcr tm^ftysMM fi HptcUllf common fn conjicct^Q 
with Uauoiatua mfobrbig the kmg stivfture and i» at once detected 
by tbc esquiKle crackhnK pvo^ced by the preaiure of ihe 5ngen upon 
Uic dfaundcd ifchL Tht ^ofkk or stHiiU tuaicd tn^iyiKina ^unlh 
lacriia a fpoW dc»cnptio«t and ui esfvolially n. Mmlc contUlJoiL 




The ivmitan jfnK vj ttttphytfma a ikc tt«icuki |iTpertro|>U& Id 

thk virietjr llw air orlli firr orerdicicnilfil. their wilU ir«ak«iH lad 

prune lo rvpttuc uid, na n rmilL (lie hing ii incrcucd b luc, iti 

aItvoIi lend la bcfMoic tusod in ccnaiQ orcu And tU drculalfaa afld 

rT|mnKllr power are ipifitly siffrrifid. 
Symptoms- 'Hir ^ymptoma atc pHirunly iticot of a chroaic bron- 
rtrafif titilt, : Miis [iIn^ ^\i^^\ or inttrrivf cyuiiMiSc dy^cn.. p^nMl«i:l or drrelopH 
ijidcrano' by ucition, and tcflain wi;ll dv£iiod and cuily 

recognued phputnl »ign>^ A conudrriibkc de^ 

ICTDC »f clI^kllJfrmA may cxbt withuut d)>|]iia-a 

or pnviilcnt 1&^^ of timnchitk yet U r^pir- 

iriii« ihr nvMi pmfmind c^tt^ nf cyaoosl^ 9M^ 

in adult valkinK pftlivnts. C?«f%. Cou^ 

mkj br varisblr in iJr-|;ree %t in prnulencr uicl 

mt]r be (by. nuHlermlely i>rodbtc:live. cir laom' 

putied by profiuc expcctonUion. In seven 

cue* U is suxnt-Mtiat <:!)«racied*tir. racfi fn- 

diTiduftl pvoxf&m bcirg jEirrally prolong 

loapection.— 'Tbt tl\n%K of tlic clitst rvprc«cnt» that of forced bdd 
■ni^pinlUTi (barrel cIh^iJ. 'Hi* U)icmpo«tcrioi dimeter U incTe4««L 
llTrqiiKJUUic An^le wiile. inim^ianwitn ibiugtiy icpWnl b> « Tcrtkvl 
^^1^ lifling incjtTncnl , ind coiuIaiiI ovcni^ mAkca pronunccit tbe tcCWiOiiy 

\tiiiiedr fmiorDUr ■»• 


Pi«.^— l^*liivin«t ^iiiF tl*»i. fttitflt >• 

ItQiudcB of mpLTition* pftftLcuUrly tlt« Acmoma^oids. The riba mi« 
I riffd, ih* iTitmpie*5 broadened uid llxe ffltpratoty drtcrnt of tl* 
thormx b proLoaged, TIic apex bc^ of the bcoil U oidioiirily invivblf, 
the neck oppcon »b<m and a etjnapMiatofy cvrvc of the itpLiml onliimp 
fnBycau«eihr'«1ir>i iJ>jip)«-Af l1illFn»v1andlhriiHrirfti ruuTnI-shoulilcrciI, 
U nidi ft one bv placed upon the b«d( Oft ft Iftbic, Ibc duait vriU M <iB<« 

rowZlCM P01)IE!£ IS tOE lIDOVCltL 



line fU tjpcsl snphyvmatom outlinr Epajc«alric pulnlion b 
cociuDOD ud Utt«n'> flign ibow« an abnomuUy fli^i ran|^ of dia- 
phngpttik ctOMcm coafirnicd by l)ie flunrucnpc wbidi ^ho sbons ***** 
Bfanoraiftllf bri^it hMqt*. 

PfllpAtliiii.— Palpailon ranfinnq Intpmlia strni rrvr^q rnfrchtfiLl 
faonilua and ipoc bcal >ii4 uniftlly m kivcr cliB^ibuxil duvvnwan) 

P«TCiittiott. — Pticuuioa dtrtbpa byp«rTt«rtinAnc«. Inw prj^iiion ol 
the luBg tnnkr. inpaired moTcmeal of tlie lim^ bawi a-nd BpLtca. 
dbplacrni«nt ol Ibe liver «n4 dimiouticD or c-niirr absrncc of the 

Awciiltettoa. The brctJb tiotmih oic cnfccfjlcil Add cxpirATfoti j» 
pfoiongtd ihou^ luUftlly km pbrhrd Rronrhlal f^Im arr oniirtArlly 
pmcnt dt the ba>c. the hnri Miinda are mufHcd, opccia-lty in the 
milral am. bni the pulmonvy Mcond Mund Ihough vnfcfbltfE may 
>bo«r fcUdrc kaaiUuAki&. la old Aiid setae ciur^ iHcuspid rrgur- < 
g^Utioii stty be pRceni. 

SecoiUAry SyiDptom*.— Tbc dloCKir tons stAndlnif tercEir cmphy- ' 
KBa a (<? c^tr^burdoi ihc pulmonary drculalioD and r'ght bnit* bcricc 
if ionmipmialirin foUovi one rruy expea to (intl thtf lytrplomi ol a 
cvdiaic leaia, Ai a OkaUcr of fact uicb 4Cren tcnmiiul *)-nipU)mi on 
nntf Cfttoonierrd Ibouf^ minor degncA of tooondary ctHij^etlion 
aAcatpfi iht <ii%m% tnliiitary ii> ibe great vr^in« are rjiirrmriy frequcnL- 1 

FORfilGH BODIES IFf THE BRONCHI. - D>in^ wbi«tlf9. niHA. 
piM. larLi. Iiuliuna. Ifwrliy. bullrci^ pefablrs. (al^c (rriht lixTib (7>ivrnti. . 
bonic»>1n)it9iooca.p«nkbcaDd4adtbc1ikemAvt>cdrai*n intoiht i^louia 
jyid vfuaJly mi promplly m the krger right bmndiui. Violent ^ugb and i 
ait hmiBrt or live alcnoUc dyipooa 4ad c^aiirMli u«ua]1f follow and 
tn aMociated with vddriy Tatybig de^«a <rf pain. II Ihc nbjcct i« 
mx CEpdkd ilfsib cri^y crwi?! in ft frw mirtutrs bu< mr*n< ofien il» 
■Itock ■ubaidaw vmJ tecondaiy influnmalMn, oltea Mppuiativc. cmun 
■nulb in lofmHuwl ftplU brancbo^pnciunonia, abai»B< or evm | 
In aomc instaiiTca c^toiuc pncvmoDia vllh or wilhout 
it Trtv\i% Bfid h^u tor motiUu or yean «ridiag rat?]y in the 
GOnunn uf ibc Umiiffi bw)?. 

DiAfiKWi^.— Tbia tW^xiti^ upon the »nanii^<ti«. riolrnt paruoyimal 
CiMjcli. ifar Rtfnixrn ray IrniEn^ an<l Iht' J»hy^k7ll signs of lixati/nl rn^ 
llnramaiion oflm aoMdolcd witb airins araui rcprcyentiTig fLlcltxioAi. 

BRONCHIECTASTS.— lEarHy mnfftniial. it ordinarily folLynn 





L OtbCf 

otbcr* (be ictafral [iin iiMJiiii note it sot 

iir lie ui 




cbronic ififlammfttlofl of thr bronchi^ nraii alane or wiih chroftk ob* 
frtrudkin and uccumiiliLlIoa of Btcrrtian, u in pulvumoir tubm^ulcBU* 
chronic pleurisy uith ^Jbcsioiu »nd relnOion oribmil ctifiukcc M Ibe 
hmp;- 1'hou|^ mrdy nnHiriRtrd mih nniip ifnujBcs. It bvt brrfi 
rep<iitr'i in influeim uk4 t>roDcku>-pin«umnr la. 

Physical Sgofi. — OjUff> oftVMr. rAiry, ttihm ptrtnt. mt mutfty tkan 
fi) $ime county, totally t4tAmg iht dMitgmikmg qtaa M ts ^} m v^mkm 
*vttpymg mftk^ikS iMVur, Henov nW di^ga^sis vf MMcAMdom mm- 
^Sy TtsU ufffH th4 fmfm4 «/ tsiuatht fMm. ike fietitHar ^axjjv 
aj f^^lk and the thofadrfiiiie tpuittm. 

Cough. — Onor or tvAn M\y. ttmMf In the mornt'kg on *ri«ing. a 
riolcDt paroxyAm ol ooughini; occurs attcnd^il br cxtniiordinj^f pn>- 
h\tf exp^Konti/ya. Thii u afioiarf in odor gny or ^yifh brovg tnd 
purulcDl aad u|un being pl^trcd in « fioM It will a^ a lime acpualc 
into three taycn, I'bc lowest Is thidi and gnniibki-, there if a ikiiik 
mucoid IrLArmrdtftlr Uyrr. vul the mrfAcr lajrr is (ironvn «nd hrthy 
(high air coaLcnl). Clion^ of atlitndc may Rrtatly influence the 
ODMt oF ocnigh. ani^ tn <.-ni[iTy (be bronrhipctalJc cavJIt aom^ jnlimts 
•MUmc Alt Altitude llml brings tht head bdow the \iody. 

ProgDiOtia. -Ihr of^ndtt^on onc« eatabHcibccI U psnnaa«nl, p ro g w* 
fijvc. Hid nur]>' rrlii-vcd u«c by ui.craljvc ranunircH. 

SPASMODIC ASTHMA. IHJittitioD.-^ r^pinS^ry mm^m cf 
Ul-d(^nfif ctfUJdAVn t kar.trlftizAi l-y mnr^ cr Un finvrv pm»xytms ^f 
tjtpk^tf^y iyi^fHii. Undinic ta chtonkily and 9ts<KUifd with Ua^kith 

Btioloey. — ]l \t oflni duM-ly utsueliilcd »)11j- of a injuiifraXalkiu ui. 
hftj kvrr, but niMny r4£(« Ahi>w bmtichlli«, poJy|iit admo^dA and auptr- 
MswtivF or hyfjrfmTpliicd lur^inatr budk:^ iniudnal auto-intudorlum 
or irrilalion- TDdnuiritioa. hplcria. nc^Mnt^lbenin ov rpilepajr^ 

Exciting C««ses^— Cireful Inquiry ihnuki be made ronf^mlnjt the 
osd^g c»uac» and ihc numb^ and vukty of the alucka^ Sncli 
p«<lei\T!i Ix^tPiir «l>>4r f'1iftrrx<rn and can oficia d«rrif>r witH ri«(cneM 
tbc diiiital }.i1ictiLiiiL-nA and apptLreni cxdUng nuiac. Ammi^l thoc 
are MJtvs of ail loiu; tho» of dnips. of rertiin flowers, of htty. of horua 
oc dn^ or guk. finh. rwiip or rnffrc; irrilan^j %uch At du«t ni fog; 
h*6t trr ceid. vhcthcT local or K^cral, Old (cAlhcr bed* and plUovt 
ktvt In mutt than onjt tni^incr pmytd raimiiw fiftori and tmtiinti 
»uch aa Lilcaaurr. imn. juy ^knd 301704. texual stijnulu i^ricf and weary 
atv alike potmi. In cerUun imtancca kt^tty m^h at nigkt and certain 
aitidea of food or drink tamj auae a adsart and m sums oka il b 



M 1^ from ^ml or InJ, bintlna) horim, uid irarifmB occupotlana 
cx poBiPg their foUowrra to duat oi iJUrralions of heal or cold maf 
exdie ■tiack« 

A Wori of Wjinuoff.— Hif ubnotl core should be obufved ti> 
uvokd ihc common vtd dUuiroot cnvir oi confounding the •O'C^IM 
"wall.*' •'wituriimal" JUJit "iflfillaf " KslhmiA with thow of ihc oftto* 
nftry vpucoodic typo, 7'hf fcrcxytmt of "rmai Mthma " sr^ ^ctntdy 
Uka floM of tnte ottAum and tlw atuf ran only b« ddnnlned by a , 
Cftrdtl eiAininalion onj q^ualitiuivc adaIt^ of the 34 bnuzn urincp 
fur Ibc ftEQftdu u« unuUy coincident vritb knv uroi etcreliou. Thi 
piciiJfl MdiPitic pArocQms produced by vieuiton of the moiIc vtb 
nuj dictrrv tfaft «lKt« bttt on Ir^rttinftldy rare. Cardiac Attitmc. 
Oidliuiy anUAC djeiown b dthcr |>rrtj«icnt fir cltaE^ctly depmdmt 
upon CERrtioQ >n<l a mspiistory in typo or a mcrt &ir hwigcr- NvvcT' 
Ibflop tn:e atthmailc aiutrki occur u Ihr mtih of wrtkcn^ h^oriii 
and ba <«cablj>bcd ftithnu the hcurl »trcti^ 11 on imp^nant fA^^lcr 
in Um tnstnwnt »nd progno«i«.* UAtfa ut chirlly «l1«c1^. th« 
nUa bciag as t*ra lu tjuc, uiil 0c/^ uf ail omct iip|ji^u in ptmina 
undci 40 and 1 vi thoM ividn' 10. /f is dMmOly an kftedUary ail» 

Theodcs a^ to Caoaation.— Five may be mentioned, iil. Brcfuh' 
W ipOMm, ir apftflnodU: ccotnciloa of the mmrks eonlmlUng hroncli- 
ial oUbcr> and. ffy p ^mmU md rweUlnx cf tf»e muatsa ^nl. Sfaim 
0f At dKfhragm, 4th. S^oiinodii tsntr*uhm «/ nf^^ injp%r^U>ty mus- 
dis. 5U1- Exvdatior trrrtKhitdUu. BnjtidiliLl ipuiti (t)^ cnDgmlon 
attd the atundmE exudation («4&d5)brp undoublpdly the moat promi 
nrai facton. whfir it is not lmpcM«fble thai oU five mity he aprnttlrc In 
^raiyuijc dcKTCCS. 

TiV)f of Attack. — Like croup, anginn ami noctuinal rpil<»p«y. at' 
tacL» <^F aatfama occw uavally at midnighl 01 in the early morning 

Am.— L^ke rpOepsf attacb of uihina nuy lie preceded t^ jat^ 
moolloiy lymptom* raco|piiaed by liic paucai, v\mon|Ett l3uw aft 
flMtUaJ dqvrndon ar ruikaikm, flniulrner. yavnin^c. Rirr^lnfc. irdifng, 
badacfcc acd polyuria^ Ordinarityt bovrcvcr* tbc Attacks wxui irith' 
out aayncfc vnning. 


prooptly acid eottplctely Rbevrd by Ln»tnittLl dirfCtrd nbolly to a 
Man aad tbfa ■J f ptriw oa b a taranoo one- 

9 ' 










flytnpiomfl.— Ibr onirt may br gnidual. but fa UKially luddM. 
Thtrc u a Bcnu of coosuiciioii of the thmt or dwA md pcoDoucced 
d>v|Kuv4 with difEculi, fCriduloai tad prriooged ecfuntiaa. In ^ait 
of ihe frcfuoed ffupog tht: ra:e a oiually tirlow ncirmnl, A nhcn. cUy, 
fcthlt coujch lAOtflKi the pntitQi's discomfon. And on ftciitc cmpkr- 
9eniA mUrpv ihr f^nh nf tV Inwrr fhrsr nr^ that Thr frmAte pftltmt. 
if atu^ltcil vhcn dicttcd* b uIjUcciI to kra*CB the dcchin^ llie ^n 
are blooikbor incf MArifig, th« vma pipffig hmI imk* tke bee 
juitlJd cyvuitic. dtnwD mid agunicFiiL The Enitid Is abvcJiitdy dcu 
and the psucot sppredB^ttt hit MScrmg and is usiuJy a-ppnhixuiTc 
vhI Fcajfol. If lahcd, the koeoi arc drawn up. the ihoiiMrn Aitr^ncril 
the Wk roundtd, tnd the hcAd Is on Lh« hand& or, yoaa rti aMj one wB 
be found 1p«nfn^ ovri a rhtir nr hri1-pn«f or thnvwn hick vfitli nuMd 
urns sfraspinf- some support Ifa&t will pvc added ptirtkim: lo the 
■ocnwry muida of inspinitioD. In ra^ny itjttt |aticnts nuh lo U 
open window, icgardkaa cil eitrcmej ol lempcnilurfr 

Emmiiuitiog of the ChetL-^Jmptcium ihowt sa Incriiwd twnl 
^rili. ilt'iiiiiKi-'i. iVfai]V(^ (ti^JwmrnE, InAdfvr di]tphr«|^, tuMaX brouh* 
iog Odd ri^d dbdoDunaJ must^tca with whitt the pftikot u wcklnte lo 
fdnforoe the rrfpinlory niu«d»^ PaJpalion. The riles are ouily Ml 
tJtd vocaI naotvuMx and fiemlUu «ie enrccbled. /Vcuiiim oimI Jnf' 
CcJIdlJtm, The lifenfl «rc ihoM deunbcd under cinphyMina w&th broodi- 
itii sirfdor HttprraiMc-d. 

Cou^Il.— This ii onluuujty forbtc uid unproduoire undl the ccd 

of an altack, whrn then nuy or may not b« n miuJdemble Amount ol 

■putuin. In cajo of port uthrcu uncomplicated by brvnchfiu ome 

' da; find the peariy gjobulec of the tatt />i a liemp aaed vrEijch rooUin 

ICtUKhimD'A Vfinh util Cbai:iixit Lc^dn: iryaiAb (m po^ tt?)- 

J*uti4, The pulM miy b« maxki^'lly w^k and acce^entcd. Durinf 

any KWTr ariack the right rfiambera ol the hean am dilated jirt 

^ death diuinK an atloclt u modt wiuaual. Dtmii^n of the Par^xpm. 

Attadci uaually end gmiiially. laa aftc^n abruptly after two or thne 

hour*, but may be thorter or ntuch bu^, usually rcciu whb in- 

cnaaing xvcniy on aucccwivt dayt and an foUowvd by a period of 


ProgcoBifl,— The atucka are Tvcurrcot and ch/onic and aAhtnatica 

may mdurr ihi^m for a rrnaanahly long life iJme, but on the averagp 

there ia. acvcdhcXcu. marked shortening of Ufc expectancy aa b prorcn 

by \iU jimiianoi^ flatiftJca Asthma <>c<'i]TTing in childhood uaoaUy de- 

, pcoda upon a removi^ cause aod n oftcA curable, TbDKca9aoccur< 



EbMwrrn ibc tgs* ^ ^^ ^^'-^ ^^ ^^ scnnctlmc* cuxcd, Uiotc ol ihe 
Dedbic period Art nnly rtuvil. «nd iJkim b p«tfcnu &boTO Ao 

wiould bdkftle that at no 4ge is the bat suicmcnt obnlutd^ Iruc 
Cuvful and tlMr>ugh tfudy of caui«tire facton nuy brinj[ rcljef in 

I aomt apptfeotly liopdca* ouo 1>u[ ihr cure of 9icci>ndftry L'ondliiona 

I ol loaftftt&ie b nmr poinbic in Ihc adulL 

PUURIST (^Cmri'iD-DeflfiltkiD. An ittflnnpuitufi iif tht 
^IpyfV, 44ttU Pt dtrpHi^ t^h or iHiA«»i an exudate ukUJi m^ h« 
tvma. bU<fdy or fmndmS. 

AppKed AnAtomy. — Each pTcuta complddy inrctt* ita tunic. <^Fp* 
b*tw w iht k>b«« lod u r«d«ftcd upon the du»t null so u to lonn i 
pdCAtk) doicd <avll)r, iboQ>»h nurmal)> p«f£cl&l and voktibI lajrrn' 
MV in doM ftppQ«iticc aod move frvdy ovrr one nnothrr, lubrJcAt«i) | An-fojny 
by tke normal Ijmpii. Thr plranJ c&rity n^nnbln a smf Eympb . "ufi,'. 
ipux xtnjctunllr contintioua vitb tbf di&phr»0in» pericardium, cervical ' 
iaatix. chza mUl and lanA. Tbr plcunl folds or liDuses acd Ttaubv'9 1 
spux Alt dbcuued vn |i«i:r St. Whm infiitvud. Uu pkwa^ turjau ^ 
6aam4M irj, pmA lie *JifiiiM gntt rue U> j>aim, f^^fgi** «^ 'A' thcraOtr 
£tAk pA^wtfJ JJf» ■/ dry fimrisy^ vii^:—ittuiibif. ojlcn paiptihU. Imthn 
tpami. A >Ufbl anack n^y r» terminate prompter without pcrma- 
MDi daeaap to the plmn, (h) ihr fibfinout extidiVE may btc^imc Trt*i^n4 
"TfT ****** lod form pleural adhcMoni of >nrtjtblc cvlcnt vid density. * °"^ 
or (c) > MKOitt aratdat^ may mult. rcUcrbg The pain by Mpaiatir^ iht v*nt 
plcunl biTcn and iu iu luni be iTabaD;bcd ur become umvertcd into 
pua [empytma} Th« thAnOMt of tht caottdate wiw graaily ^ili the 
f%mt ei the pkunsy and iltc OAluit at Ibe fenu piarni. filitMy fluli ! 
iBovl ollcn icjdJcciLos mAli^uikt powtht iif the lucfc o^d pleurn. /^unv- Euiikiii 
Smi 4xwSMf k ustiaUf the lefult of ne^fertrd effuiion. but it ofun 
primofy. patlkulaHy Sa the caaa modatcd wiXh the lobar pncuinonui 
ol chOdrea. U oat he%T% in mfnd the Important Ktrudum conlained 
(a Ite Bkodiasdmira. one nm feadi|)r apprecalc iIk impnituice nf ihr 
pfCVBie i^Fi^ilomft virf tife degm of dinptaocmcnt of the bcxrl m a t'r^v^wrv 
ranlt ol Inrge unibtcral dliuaont- The lung ni the ^etrd tldr^ I0 ^^'^^ 
cottpccflvcd from bdovr upivrard and tanraiidi ha toot fori pojuu with 
Ibe iamai flf cmdaie and may fPtnftiD penkAnrntly rrfpple'l iiid 
bousd ilown by adbesrou afier rvMrplion oi lire rtudatc. Tlcriruy u 
Uomit ianriibty prta?n( in k^r pneumonia. buT in atlulti it \f teldam ; 
a«viriatrd Kith 1 nuuknJ d^j^ir? of r^uaioji^ Jc u g^rrally l>rlleifjt . 
tbai [he |pr«alcr anmbef of >o caBcd sijuplc pIcuii&kA it^ttafxX %\iMif>-\ 


HBOVCAL nua«08B. 







betf tototolorii SJiil the Mtalij^iLcs »r fnrdgn otMcncn ahow a prrcvfit- 
Agc of tutrcrculoua picuruicB niiging from >5-9G%^* 

Edology.-'Thf fnntnrncoociif. 9Uiph]rlo(wai& BtiFptocDcniJi uii 
tubercle booUui may be found ftbnc or in cnxrlibatba in cutA of 
puruknt pkunsy and v> th(«fr may be tdded the inButfttt, tjpbo&d 
and uAati tadllu*. I'trurthv mi^y sj'P^' ^ * cowjiUcatum ot nkdoiB 
diiwiw^i Kint in imporiAOcc &k tubcrculosia. Inbtr p&cmiMiim mnd 
pericu<dilb. but pniconilu. tnfluenan aoile rhvumaiism and dirooic 
oepbriiii ut froqucnL It toar occur in ib< ncuithenute. in typhobi 
fever ud ihe actiie inf«iJniu dUusei genenJIjr. ju well u In govt, 
iiirook di*nM« of the livtj nnd gall-bUdder. wkd b ctticer. Tkvi' 
mitiim ol (he c^lhX nlth »r uithaut |jrrfAciliAn may cau«e It- 

SymptOQUof AcuteFibriDou»P1tttrl«r.— (i>. i'atr.uauall/nxKl- 
cffite in degne vtd luting but a few d>y9. (0)- /*«»!. most oehr^ 
mrmly fell in Ihe ftrtllATy or infnnuunmar^ ir^on yet tametlmet aor 
iocallr^d at the K&l of the prvsooft, but referred Ici lie lennlnaiions of 
Ihe Intenyialnix or even do thp toimd ildr. I? ntty be fiieii, Blabbuifc 
cir Uiuotini; ia cliAfaUer, And b inurued by devji brvathing ini ornigh. 
The fact thut abdomiiul pmin amy be pleimtic i& origin ibould never 
be forjcntien fcr nrtavy important mrsfni] cymrt^Tlonfi rnjiy he cfmnlittH. 
is). CfU£k- thfts ij hutb. DOpffodiacdvc^ pjilnfn] jind nupprcwd. (4). 
\FrkH»n; AUMultatfon yleldn a fihufflJng <rMking, tqiieoilEing. or even 
' a cndiling sound umuliUing &! timet Udc otpilatku cic eicD rhanchip 
but perosting after cotagh. niperfidai In chvacier and xifuoUy occurrf n^ 
mr!y in ihr Irupinrtory phue of a rcspinuinn- Prictfon li ofim palpable 
OA well lU audible. 

PtayKical fflgns. -ftupf^iim TPvrnU nhjillov raichy bTrathinft. 
compantiTc rnimobitiiy of the affccled sidci tisd painful o^u^b- 
Tbe patient*^ <fecuUiti« b varitble^ oft«niim«« he liet upon the a£ec1cd 
ilde u if lo lirmt iu mcrvcroent during the sligc of contEcAfoa and 
S^vt greater Uiiliade to the expondcm of the aound ddc after dTitfum. 

DIaphnLgmatic Pleurivy.— The |i1eurt«y msy mil extenri beyond 
the diaphrAicmalic surfuc but usually other porUonj ue iiiTclml 
The physfral sig^u inay be abwnt or be ihoee of aruie pburuy. wiib 
fever, rigid abdonJnol znuaclfs. coiUl breathing And ah cxinordiiuiy 
degree of pAin on bmlhtn;^ ewiSMwiqjc, talking ^ad Uof^hlng and 
lendcmesiei orci ibe re^n of ihic lofh rib. Il may bearuie or rhmnie, 
diy or vet, •renin or punilcrl anil ihe exccnfve ep'^aAtric or infierior 

*Th<M are burd upon ilif injection of l&rBc Amounta of eroAAte lattv 
nu^tlUe uilnuli. 




Duinpal thondc puD iteccdjrfr duiphnf^rutic movement even of 
tf ght degrrv it the diff f f^mpEoin, 

Pleiuiiy with BffwiOD.'-rAt firH t/ja.! ujjtgaufn ii te Mfi<trj:e 
tkt %Hf4mt4 tmfactt, i«timr pcitt ^mS dtmmuh Utt isrnt of (whcfn 
f ww tfr l^e fluid gjaviUlea ta tbc iiiu»i deprndeul pcdtiimB. &nd il 
sot CKopouUltd bjr tdhesiou ls movnblr and slightlr or ourkviUy 
cliuflnluleveLteooidlngloiNpoiUliflnof ihe pcitiuit nnd fht^ amount 
of cffwiM. O*ioc 1i> tibe cmformtlion of ilic dicsi «nd the pcculi^ 
uStiet of iDtpmil prrwiirc lb? upprr lifif nl 
pktmJ cfftttion oflca makes an S4ikc curve. 
mxiUng hi nruLxinium hdf^ht in Ihr mJd- 
jiilUry Iht If tbc fluid rrsicbo iht cnidtllc 
'>! 1^ axnnd rb thj» nursT dlutppcor^^ 

Phjndcftl &{iu. Inspection.— One nocu 
iniinobilitx of (be diTcctcd ti^ flush lotcr 
ipa«M^* Incnuvd ffyspna<x, »Uh cyvt<aia or 

.r%h Jni" %!TilMiiifS nee b ciUrme taici liviJJiy, and.n^i^Utc- 

I I irufi ^ffni|»«ow. mCEil <jf ibc bcftrl 1i> ihc opnciilc lidc Vp'bich 
'■ ucil<ii Brit » Ln . . ■ . ;, - ■ I 

-Ml.' 'I1I.B4P iTiftv ciirTy ihr vS^mlp rantlnr Impitlv <□ Inr 

4iiLU on ibc l^lt ^<k or to ihc ri|Ehl raid- 
davlmltr tine. Oaaiion^lj tn mudenip l«ft-«idecl efftujon tu^ c^rHJac 
inpubc a rbiblc. 
PAlp4liOD.— i'oIfatioEi AoTibmis iaipeoioa. Palpalofy ftrmitvm 

mttt, de cided l y dUTcrinjE from ibat of oouolUklion and Aioiulttcd only 

ik€ fuid ankncrty, ik$ nok is vfkn hypfrrtMnani or ty^npanitic in 
qtolitjr ^Slod&ic rpKOftiiceJL little dilbculty u ordiaohty «n<^ounirn-'.t 
in ddijriitiiig ibe upper bonier of the cflusion nr in fUl^iwing jU >Iow 
ohentionft of kvd wlib cbftn^ of poflturv. Fotitrifrty, dadneis daU 
i« a tamfruud hm{ may be nvounlfTed anij wril alKivr the- fluid level 
io ttHfcfaiwrf vffuKNU the unaS^cied tbouc m^ir yUld Ibc b7p<'r' 
KKmutot of vicviotu empbyvma. M<n>ablc dulnnt in rnivf^r'i 
f ^iwTiii tf f tfiKe often icvoib vci)' »jnAll cxuduieu Lf light pcxcuwDo 
a ued- TAe b^ u rKtf tyfitjiffy fial bul pauti tharpiy jrom slight 
Aiftvu A) ^an itamock iympimy m \hc patlrni chaji^^'V fnim tbc erett 
10 the ftcuflbbetti poAon. 

AaSCBlttdOD-— ^ver the eamprmrfl lung posteriorly the breaibing 



UuiiLsl cuii<j>Jty in aliu^il*: 4icu1jt' 

u tubukr but bclioT the kvd of the diud tbc Toke ukd brcaih joundi 
Ml iimto^<ititcufTKi. r)t^«{k uUom iHiiWy to: OwdwckjiicclMn 
ai dtMtta «iid evm in ndulu OOCidiKttd tVMllt aoOIH^ nur "QW^ 
tnic coiuolitUtbix' thouish ujually 0/ « iJi«Jant qutlity. PlciuJtic 
frialan vaty bf b^rd abf>v« :ht \irtt\ of ifaf flulcl. ptfiinilirfy if ibii 
i» r^ooding aad nuj ptniM foi long periods cither ta hktha orocpi' 
la lion 

Blca»uiAtioi].--Tn ki^ dTiwiont the nicMVicmcm of llw lilccled 
■id« U £acrc(tful 

Ptuoroficopy-— Tbe dUphragm of the affecTfd fif4« ts townd ind 
^owa a irrtatlv kaocTifd rcspirtttory cxcunion xm^ iLc: Suid h <leftriy 
in4itatpd bv tbc cormpondmg thadoir. 

Rbythioic Lateral Dispkccrocnt d the Ileart*— In jgoj, Uk«<- 
thorre[>ortedtoUcn^aEioTubucdupcin£nurnbcrof cUB«of plvuritJccflii' 
ilon wblcb iniliotcvl tlwt ihitcofiilJtion ntigM ti« tcfwntcly dbgnMticainl 
by fluoTMropic methods, or even bv ausailt&iory prrcuABion tnd oc<a- 
sionBlly by Jniprction. H^ foLind chat m the pT«mre of a cnn«id«r>blt 
iimklcnl cfhoMiu the hc4rE< in addition to iu diiplAiCciEicoL tbowcd ■ 
dUtina LalcnU movement oi reipirtlofy rhythm wytng whh the d«pch 
of mtpiratLon and iLc aruount of rOuiuuii. In wmr uuqi* Uie Mpr^ 
hdal ktofi imptdu could be Mcn to move from vide to side; in oeorly 
jitL atiMkitratrry p^rmnjon rcrilir>1 the obsrrvfttiaap and in every cue 
the duar^>ifopic findingi vrcrc pfdiiivc^ The fdMiMra£iu>& •ecen* (0 
depend dvkjiy uj»on the putoii'likc action of lh« dltphngro fin- 
Ic»lcd by llic litrukt ol tbc abdomiiu] muattcfl. In f(dl hvqurv- 
lion proauft I* relieved by the dtttenr of Ihe diaphngm and the 
ctpiuiioQ of the chat, tad thr rratfilj movahlr hrair Ecndi to a]^ 
proNch the mcdlDtt line. In forced explratioi^* the nriinji QuiJ ooluinal 
and thf aanovli^ chest force the ori^ itvay fmm the medlaii lint, 
Mincliaia to ihe exieat i>1 two Eflcbc«. The imporiuicc of the obocr- 
mloo d^VQda upwi the fact thai it tt dom nor occur under coodiHont 
»uch as lubdiapluagmatic nbicoa or in other condiuoiu Ukely to be 
COQiotinded with p]curuy» eitber lemus or puruicnL Tiu lUMmmm 
T^nzt of m4fvenijmt ffcam i/t Burffim sti/nt rffiaimi; in vtry smt^ ffrnjiatit 

*Re<>eni1y the iwllkor removed Tver 1500 c^ of tcnut fluid from dd 
elderly pAliDol in vh«n pur* tubular brMthinir wu marked Lbrou^houi the 
area of lk(Ti««, 

tNrw York Mrdji^ Journal, tfov^ Tnauirtinni ol thv Ateoeutim of 
American Phyiiciiint. too^. 

1 Id ercry iav t» far etainiiicd the Upprr bunlrr of llir cfTuaiori fKu 
Kcii lo rue ui etptntiutL 


Ifcw ii fndSeatty w ■wwwwl,' li» fnumtf fffiuian hath Ike tikst and 
<<ii^Vttpw dw ofiwtfi pittnttf, yd in no viich r^iu to far nharn'M hu 
ll>c lUtkoT f^Qikil an trtJrc aEjimcc uf upwaril iLiusl auci Iditral Liuxliac 
<liipUcv&>at. Hrnc* he tuu not bf«n &t^« to cunfinn the ftlaitfme&t 
mde hj cnUm wrilers m the effect that io mjuw'v« |jlrurCd» ilic 
^*"f*—gn ■ compiadf tnuMibile and nuy «xc bul^f^ ldco chc abdom 
fafllcavftj. IneveiycueacifMibflfrvtflihediRphrii^^ nn ihc ijfrcifd 
iidc hu ^wn movtmcnl of frlmc depict kB<l niBff If the ^t'dortiiriHJ 
amadit ofl ilTon^T, F^ttd rrtfii^otieK i< neotoary and might drmand 
ihc exhibition d morphia if potn were sevcTC. Jn no uutancc go f«r 
obacrvod hu Ihia b««a necwaary. 

EHFTEMA.— SfDipbniUv — To ihc »jtnptoin» of wmui dTuKbn ore 

asd. la fdM buUUK*M. a^tmai bul^mg •} At ^tlUrspaiti or Okr eicapt 
«/ ^ AvM 1^ pUmid Cirvily tMrough Ihe inkrcviiti tf*t<e ttfinrr ii 
/anM a Aovf AfnmfA lk4 ttin xni miy cauw on iniractibl* futula 
thfoa^ sponLincoui mprmr. Such pcrforatioiu iwully occur in 
the aotvrO'Ulcnl portion of ibe cheai- The urine mny ihow ttlhumoit 
(aee ft 3>£)^ Trarkrfl ImnuTKvtJfl la tbo niLf. the itvmgr rotirt hrJn^ 
aboai i&ooo and Crvr falling below tJ,tiQQ,* and ibc blood may 
ibav lodophah fw« p. ^icm> 

Tbe Uae cf the Hypodemuc Iteedle- — A^piiation ciay scmcllinca 
b« pctfonned wilfc on ordjoary hy-podctmic syringr. but one uRuaUj 
needs one i>f ihe Urjp-r sfringn of the wune tyi)c with a lon^ nccdte 
ol ptaler catfbn. Such aa exKniDAtioa, pcrfbnutd un-icr ;>rvptr 
antlwpcic prf(iiuth)nL h abaoltn^ly wivhcnit danger f^vrn itif^iigh tti^ 
Qcedlc cnten the lurif*. The phyvld-ui'a Gngen laid upcc the ribs 
tbotiTd nirk the lifrriti of tfae inlcnpocF ind the nr^rJlp should be 
IhruK quLcLlir and deeply beluceri them wuhuul li^iuJiinj; Itir rilx tf 
flnid be prcMnl uid the point enicnd bo nnderad anesthetic? by the 
ctb)f dibriik «pray ihr prrirrdurt ia fiainftsa. Thrsitruf ihr [junciun 
iaonfiDantrihcsthinlCT^pacetn Itc xiiUary line, but it b often nMCoaory 
to enrer Tfaf cbed al olhcr pointa feppotfrling maximal dulneai and if 
care be lakta to a^oid ibc heart, apteen, liver and dJaphraitm the cf;craIor 
haa a wide tatrlude. 

PlanHtlc Adhcalona.— A rltnfcal dUgnnels of alight ac!h«sIona 
ia often knpoadble, but in generaJn the sjiaptonia oie aifoUowa; - 





ilmoii niL 

* In tUoph HiQua plniriiT a few mn oujr ihow moderate leucDcrtoab 
4athi|t the kbrile peibd. W k ^s uic* cuacnlEicd by R. C- Cabti^Vbut . 
avcxsfB anmtwu 8,8jei imA mocJy 9 did it exceed titMO. 


mMcM. MAomMis. 


Jtuf^avm thf}vn impAind mAVcmcfit of the ftffMierl flMe or mme- 
tlon If ^evtenWTC wlbatsiu 4r« prcseat tad LlUctt'a iJp nujr abow 
marietd^i&tpttincMnt i>f tb« clUphn^fttic «icuniDn on the al1«c(Kl bde^ 

Paiftthtt abow dimimiibcKl vixal frcmidis anil koMveJ cspmrfon. 

iVnujiMi show* ft chckago of aoU vorjiDK Eronn iliiibt iiinf to 
ifaaolute fljUsicM ■coonUng to the extent iml denaby d ibe aifiwtluL 
^itfarfmitfii 9lLt>wi dimifiywd breath t»aA(fa tad rokc co«<lactioB. 
AAdttflciMhnti In ccTtaiD xrrM pL^uiitk rll«a 

PluorDMOpy<-~A dtsUiKl bhadw indicstca ciitiuare odhraiocis uid 
\ht diAphn^Atic iTOveiimii U marltnJlT inapoirod. 

laUriobar PIcufitrf.— Tttk ordioaHIy ukc« Ibe Ibm >i>d pt^ 
MfiU tbc ^mpionu of ftn ineericb«f abtcos ntiutfd bcfwtcs the 
ufiprr xnd midillc bhn deur the root nf ihc tTin^ Ii finrarnii pMt 
dtfficullia lo Uic diftfnoilIciftA «nd b ofdiit&Hijr mLilakcn for true 
pulnxnuLiy Abtcnt oo accauei of iu peculiar location. The pitndeni 
eccumdotkm stay rtij fcom »a oLinoc or two lo & [MtU or laorc. It 
ordinarily foDowa a gentnl pleurisy. 

duDnic PleufUles.— Thcif fnny he dry or vel. Brrauft nr pcfu* 
Lent, and for ibc moat part prcactit the aatnc pbjdcftl ngas 1:1 arc 
foUQ J ID icui« disease^ Cbronic pleumin are tisunlly inberoiloua lAd 
tbc MCie may be aaJd of diroi^c erapyeou* but tbcy often tvpnacni 
ncj^cacd non-fipcdfic fiifi Maltgpaat diseaae of the ptcvn b al- 
tci^ilral by hemor^«^ dToskxi wid chrontc inftanninaiiLin- 
£C<iur«fl acid Tormiiutbii of Pleurisy.— J»m^ fhtik pUmnty 
rani ill tourae in a few days, leaving bphind, onU&arily. a few adbe- 
skiiu often disooTcrabk: only at poet nuirtcaL in t^xt idth imfm 
t^Micm kqnradon ia uaualty Toquntd* but spontaneous mbeorpclon la 
not uncomiQoOi Cmpyeiiu ordloarflr dcounde aurKfcal bnerhmicc 
lAd leaves behind % unable araa ol tbidcened «Ih«n-nt pleun, ax^d a 
mon riT Ten rripplol lungs 

PlfEUHaTUORAX--D«fijaitioa.-.1» eftwon ^ ok M> Urn 
fitmol amiy. An piudate Is abnoei invariably present, and th£ mie 
d$siriptkn lermd art hytUaprwrnufUmax aW ^yvfn^wwUurn^. iIjc lai- 
Eat t>cing the conmon Icnn. 

Btiolosyi 'By Ur Lhi^ gtuOci number ity^c) in ji»ft>dalrd vlih 
advanced LuborcuJow of the lung and the formntion of « fishdoue 
cominuidcatifHi, tkoush in negUclnl empyemit n fisUilonu opming 
mi^ «elginntc in the pleura, Amongit other cuiao inar ^ m^ctioaed 
peraetmln^ woiirula of ibc died wall, tratiroftifc rupture of ibe lung, 
mptuft of emphyscmntou* T^clce* pukuoary abaccaa, gangrene* in- 


tartt. CMCVT And cvai fcT4iildt. N«*Tlir ftll of iheauBvocmrtnmalM 
■n<l (tic tiiscwc ]a int^nahXj unilaUrjJ; nutiiicr and rompictc biUlciul 
pofumotbonx hhowUi cnuM 4lfnoat liut&ni dmih. 

H«rbid AnaUimy. — Tfac ijr in llu? pleural caivhy i» ordijuml? 
p«ll^lc4 M tbnraj^ a sng^ rolre like opening b^ ihe rospicntary ' 
roo wi neot*. llms cnftdng matkcd inmiplFuml pmnitr. The lung u 
compr ej aod in the dSfcCtion of its rpoi- mc^iiuiinjil tlsfucs arc dw- 
ptaccd tcMvatdl the onaffrcltd »idr. dUphn^millc mnvtmcnl is ^LinoSE 
wImJIt vtKiUilkdt the pkur* bcojcin inflacinl ant\ in moai ciiaCA n 
imjCi gifujbAJ of punilrnt, nrelj a Jieroiu eflujiion, u prvMat- 

S]rmpt4UBtt.^rJhr onus ii druAtl invanoN^ jtajj^ whaicver mav 
be Ibe GBUK Mkd folknrs directly upon mjaryn physical ttrtdn. vomit 
tug. (ir, pinrr frrqiiFT^ilj. a peumymn of rcuiph. SymfkIm-^ £J ihock 
Mt pmnU, Ihnx it 9^f4ni dyspmEO, tycwjU auj livitiity, j«J J/k pit' 
iUm triim^niy JttU IM tk^tt ksn httm tt^}U -'iwifrmU rMpfurr." An* 
ioiiiJiaua ooset i» nn aod the Author hu oboctvod but one >uch cue; 
In mdi the ApenHau i> liay wid obtfnict«<J «o IfaAl only ih« imalWt 
quu«fck« od air jRAmAimtfy mrrr rhr p]«*Tiro1 ravlty 

PliyilMl SAfflM^-— Impettitm sfaowt tmmobilily anJ bulging of the 
aflKttd fide evidmcv at a ilisfilacrd hnrt anri (mUtitrnlly {Tn{.eircil 
<Bapbiicmatk movement, iht phjwffvamy of itiodc, cj-uicok and 
evidence of vutkcfl dytpnan- Pcipaiiott oofi€rm« inspection (uid 
local frentimx k oTdiaarllj jercAily dliDinichcnl nr entJnty l^*L Thr 
^^rCHtAcKi note b ordinariljr dfaiin<tty LympAnitic thifu^ti unJrr oon 
rfbioni of ntrrmr pimiire <]vil* « mnrktut i1i>grrr fyl *h\ilun» may br 
iotKbd. AuMy/Mi^m. Bitalh nad voice pounds aie ffcble »fid diat^ni 
or entinfv abmt U ihc patieoi be raat*d Eo a titling pocrure uid 
|«MU[y skakca ffV^p^i^rulu juciuJMfi b obufncd. Thit U merely 
fc «fill«binf flOUDid mdily delected if ihe eu t« applied Ut tfac cheat 
dorfng the oanorttric acd «jt«n beani at arrmc little dist&iiee. An 
«M|tti«iH9 mcMifhC UtMimg h piOMnC in many tun u is the Citin tmnd, 
oblakied by ptacinf; thr rar ijpoD thr chrsi vail anicriorly an^f hainTig 
an onftAat p^icc a good aicd sihrcr cf gold ccin oa the bade and tap 
it mitk utotber, the conduciod sound having a muidcal, bell-like or 
dew BkcUik Hog. 

Cordfaat QeBB.—'llie Ihrco caMInal tifpA ut: mOMc Pini/inx. 
HipfeenUc ntaa&MiM, anil Ihr c^ aaimd. but aJl of Ihe aignt art 
ordinufly •» dear (lul ot^ error in diai;na!ua can seldom occur, /n 

Mvd^ wUk frm tmouih miU (ice ^i. joj}. In JM^Arjfnalh; Wmia | 

111 Wlifll, 









lite libtoiy* 1>jrburyKmi fnimbtm);. (ix>iii£) anJ (he ch&iict ol ddU 
<m tubing LiTjEc f^uAntiEin af val«r inlo tJi« tlomach or tcdatng it 
with ait ftuUt in dliTcnmlktion 

CouTM ao<l Teraiinalion,— The ccune d pAcumiMhorAi itcpesdi 
rbJrAy iipcin ir« t^mi^, nml ^ rhnst luvkrlMni wlthrhrnnk nihi^rviiloili 
(90^) *^ Almoet invannbly EAta.L> ibc DorlalHr a cnormoutL 

HYDROTHORAX.— Thk 11 1 vroui pleuritic ffftsion B-iUiouT 
picutltii wid is A xcondajy nilmcnt. umall/ biUtctoL laaotiated villi 
cardJot Kif^ rcniiJ r^ifir.iM! or tcmuji&l AtiamiM ttJid uchcxiu. 

LOBAR PrrEUMOrfTA.— (Pncotnooilfn, CtoupouK Pnemiio- 
nin, Luitc FCT«r).- Definition.— /(n a^vtr in}f<liiiH tiutaiimtpi ^ 

am ifbtMpi otu^ and irmivu/icn. 

0«rniS-— Tbou;{h found in DormAl burcaJ socrtiiioii uid dHOUCi 
othct ihaa [jQeumonttu Fr&nkcl'^ iLlplix^icrus |>n«uTii<iiilv or mlcn^' 

jcoccuA 1anc«ol*luf b bclioverl to be Oie moat fftqucnt caJ4C of th« 
dim^r. It ui prritrvl ctinslAnrly in l\w stXW^t of iumc pcry^ns. hjkI h 
foucid in the Kcoaikxy pnxcuts of the tlbeftjc^ It is cUiplk^ Ibc 

,luiteolAl«i occurring m psLinfta^mfputumuiordmimly mcLptvlfttvd* 
II* mftrkcd itKinbltti^tr lo ilx TiicnijiKV^utms in iiiicrraiL^ii; bciatuc 

'of lb« ooisddeacv oJ incmu^d po«ttmoai& fedda&c* and moriAlity 
wilb ifpidtmics of irrrbro-si)lnj.l f<rr*r 
Uorbid Anatomy.— Thrr? itaf?c« of the ducAx tat rccof&ieod Far 

, purpncs of n^nvftilcncvn but uT nften Ucad^ at auiopcy. (t). 

, C^ttitkm. The lunK t« i^nUrKcii> (Urk red. let* ckidc thu nac— t 
on Mdion Irothy itnl liquid <nd«, cnpiiAtJoa ia iEDpaiml but aactiou 

I wilt Sddi DC wjiit^. The mictTAtirptf shafts marked apiUai? lxtrgi» 

1 cencc and efythrocjtw. leucpcyle* and dMqntmikicd rpifhelivim. (»). 
^n^ hxpatkatUm (cnEudirUlfonV '[^p nfipeamncc bum fini utivj^ 
buL tbe lung doei riot crepitate. i« friable, and aedioM aink in wiiter 

jllie cat furfacr li finely jp^Jtulsf, ibe midad iantm la bloody inoi 
frelhy) and minute Jibrinoin plugs may be 9cnpt4 from ihc aurbce^ 
The mitrascef^ sbowi a oodgubte-l fibrinous eiudftze and fibrtnouf 
thrradsi balding in mr*h rttji numbcn of eryihmcyira. Iruocxyiat, 
and desquamated alvoc^ celia, T^ient I^ m^rkud Mund cell in£lln- 
ttofi of ihe EnieralvroUr avpta. (3}. Grey V^niisjIfcHi (moliilfoo). 

* It ii rvodilT lUined a* foVovi- — (il Uake thin iniMT) dry in air and 
fix by heat- (Si Ovpcr aurfarr wiih tlie Hlu uain (umtian v^lri. lotur- 

tieun tUh. ((]) Wjuh ^Ith co|rper niipbaic aotuilon (aow)- (e) Drj and 
moonu The ccrm w Gnm poaitivc 

The gruf ooJot du^MC* tlie dkrit red nf toniicstJcai Mid ooaaalldailon. 
Ibr hinf: T^idlj^ loftvmit bccomM ia»n otpEuat, but U siiU frUt>l» 
and « jKir^ltfTLl rtudntr tollott* the fetiifr A» n mull of l!ic uih- 
aidClUC of inflikmniAli^a aad hyperemia, liqiigiaction of the corpuscli!^ 
Wid ibnn (ikft pbtp through a digvtivie f^ncCTLi pottcm^rl by ttw 
InicocjteSy the tcltuUr d?:x>cna undergo fMiy ai^d frikAuUr dcfCDcia- 
Ikn, wd. wJiJun fnxn two to foar weeks. ikb«0Tp11nft takini^ plus 
ibrmfb il» Ijrmplniici topihcr with itn etpccioraiinn triTin^f^ thc 
ittlUanuiorjr pr»duci& Thn Atraliort of tkf Hasf* of fnmfrtoma u 
rvinmriy virUhle. ConMliduiiira mnj br complete in a frvr houn. 
but wuaUj Ukc9 from u \o 14. The hcpauulicoi pcdod varies (Ktra 
three d^ to two vrwki or more liom three to n^ii« dayt being tfa? 
iMtuI period. The progoB of nauluiloa u wundcr/ully TBpid. and 
with dM comiag the wbok eoen|ile«io& of lfa« case chtAgca in a lew 

Potnti ol ImpofUnca.— The morbid Miatomr make* dear the 
phpie&l ligiu of the dis^ue, but one ihotitd remember fhii nretj con- 
liguoua lo wnauliilatioD an hjpcnctnic aud cdciitHtou& and tlut bronch- 
iiijBfid pleuri^ are inTafiablaaccompanimtitlaol fulljr dw«lopad lobar 

poniCMnia. n^itrific cfTualijn U mmpomtivrly idzghl aciJ uauuUy uii- 
dbciOTCnble by phydcai cxaminalioc, 

Picdiapoaing Facton.— fio or 7^ nf all atsct t^cear in mt]r« and 
tfi the Uniicd State* the colored people auller nwit than the nhittj, 
ChJIdftA hetwern i^e «fM of two and tfx art espedaUy hutreptlbk 
and alter an Lnlcival of ratklive iniinijruiy iia fncklctio: anil moiiality 1 
ataadilf incivoM Icom pubertj to M ag«^ Hetic« is inddenc* and 1 
moriailjtf it b a disease of the e ati eqwa of life, ll ia mmt prevalent in , 
ihelaCc wioter andtoitf sprinjCH isprcjcnl in AUdvJtjaed couainc^nhal ' 
ever thdr lAlirude or tUmatlc cnmlitiona, inl i» pf^uliarly Inut in tnmr 
hilli ftltiludc regjon^ aa b Butte. Mant., wlicit the ekvalion and 
MMller JuBwa make (1 accptionally Jnadl^. AlcoboUam, aciite ur 
chroAk. ia a maiked ptedtspoaiixg factor itararombljr affeahig prog- 
Aosia and many aoite " [Irunk^*' tux br<]U|chl 10 the police atation tni 
fining ffnm an unnrxi^fxcd [mmmonlTi. fnit^ip aikI mpoiumn cmld 
and «vt U ojncidcrtl are £sip«runt lactora. one attack invite* aihtn 
and aa ajtoabhJng niLinber of ivcurTenc« haT* bean raported in the 
mMjt bdind«ai CM in Uaelf muM be regarded mctdj oa a mcxna 
Of depfiifttg vitality aad lowerio^ lesiataoce and h more potent when . 
rambned vkfa daHipinu> Coryia and brondiitlA often |)fecrdc t^ | 
atlDck, and no doobt Fumuh a favoiaUe soU for ihc dcNi:V>\nnEn)L tA 






mcriuti , 

Hid •mi^F 




th« ijiplococci Chronic iliM«*e may ptay > pramEocfii jMirt, tfd 
prwumoala i» i frr^urnr irrmind ^mi b uuie or armin] pulmoBAj) 
tubcrculoslflt dvonic ncphLritiik diftbdo. cardiioarA. akf1eri^«clcniak 

procTali^: hypcrtn^phy ^i/iJ chronic bcnrt disc>i««^ 

Varieties of Pticumocia.^ — Fncumvaui m^iy tvmfiUait amy ttct/k 
imfttkttia titttcst and n cippdnlly trcqutnc m inHucnia. Tkt Urm 
''iyphdit" pti^vnti'nia aIk-M ht umfim^i lit ptcumtrnM wUh an o^^- 
whelming hxtmia \ehkk pntduca a typhoid ftaie. vol icr pftntm^ma 
eomplkating typhoid jfvcr. Tfnumutu pti^um^nui is nir, migroUrj 
pnattfitaUs boUi uDiuuol ond intcrcilinjc, l/aj;n« putumtmi^ Ktt 
vomeiimcA c^nritunli^rrd Ui vhlrli tlic ivtxjp bronrh} arc plug^l mnd 
Uic pLj^cuJ ftiKiib ffivjijy vWbnO bv lupimaakfu of ium^U1iOi> 
plitnomcao. AffhfiU pHntmt/nui puuri tjprtttUly in tha ^g^, uid il 
^ould bi- rrninnbL-rrd thai saiiU pncmnaniai may hfi fAtff, Ai^ 
/rtwr, c<ittxh, crisis, t.xptxiomlvm aini iypkal pA>»r^ W"'- Centtoi 
i ^n/u«H<>Hfnj art i^tn mUlpjulfngn and it THny Iw d*yt brf*>re ihr 
ptfuccii rtAcJtra the auHacc ajtcl yickk jjhynii;4l at|:fi« of ■ poticiTE 

Delayed Rettolutuiiu— In tbc aiitbnr'ft piiw ricnce Umg Jd$ye4 iwo' 
luiiort U AQ ciircmd)' r&rc c^yqI* luupUy pruvin^ to be an ciDpycma- 
hiii hIaw TvmlTiilfin la rammon. pAnlmiariy In the lobar parumonJa 
of diiMrTji> 

S«1acliv« Pointt.--The ri^l Ijng i» &9«cied in iLbout 6c^c* the left 
b 3d^> and both In froin lo lo 15^^ of ill csks^ Aa it^vd* Ibe 
lobe* affrclcd, apca pneumonia occurs i& about ^ oi tb« cttca isd 
the whole lunj; U affprtrrl Ahniit a& ofim !U k ibr Inwrr tohr alnnr* in 
which thr lofUnunAlion UfUAlly <oniEncncca. 

General ConuD^nt. — In Ihne UnHfd Slat«t fmm 70.000 to So^ooo 
cf OUT people die c»zh year of lobar pneumonia, and the diV^uc U ftp- 
|:«|ie(itly increosiaK- AaOskrsayti. it u the real "CB|itain of ibe Men 
of Death," and tlrt true ''friend of ihe aicvd" Its sppartnt Inorve 
may be due to more careful method* of dkagnosia. but il la probable 
thet other bcton are opmtive. 

Symptoms. -'The ordinary sympton^a of pneurin>Tiia are faV CAtf- 
Iwifif or npc^Lted rifEon, for whieh eonvuluiMtj) may bf Eubuiltiievl in 
dilldrcn, (bV I^tvrr. Risiii^ sbrxiptly from noniiaJ to it>3-tCi° F, aiid 
trading lo ssmdc a continuous form, it IsaIs throujclioui the period ol 
rxyoffmkm uvi hrfuEunlkin {ordinarily ftnta 3 to 14 fliys) and tPintin 
ates by criaii it). Cnjii. A ailJaJ drop In temperature ind ibe 
dnuaazit eoQmat between interne luffeilng and rdiine ctiitifort U an 

jihrnnmrnnn The Ul unullf ntcte rabDonnd ftitd v 

IftTwM Bqp IHCitbff ^r iitrhoja dJurhiza. ImmcduticLr bcfort h ihcrc 

nifty be ft imAoI riftc in Unpcntliir^ i\'n critical); followtn^ It there 

riMybeft»condaJ7^ffviitonrftpMly 4iib^*lin|(r'inftTTnftl<piwMritic»l). 

A pMttd^ criHs mar occur wad nm taUac bopc^ uiJ finally, om anh- 

BwrSflM riu iv /d& nuy occtir. The lavi^r U moat miilradiag, but u 

ordlnanty lauciaied irith oihcr flgn* of (mpt^rKimg dc4th lh«l nbciulL] 

pnfVBl inttconctnulion, (d). Pain i% olmc^t invjimblv present ftfirl 

£j 4W<dfy flf^Mc in lyfe. (r) Cmi^A a>u/ /:xj>^Airi^jry7i fii rhe 

eariy ^K'' ^^ cou^ hdrf, ptiitM and utLproductfvo. ihE tpulum ib 

' It fifTi xant and mucoid, tfatn muco-puril^Tif and blood -MrvakisI, 

Utct. daring hqMdciticfi. it become* lusiy and dtmng rcvlmbn 

oeftmy, in tppcitftnce- The aptly nainnl "pnmo juice'* aputum it of 

striout pQTLcnl >nd die sputum of ihc firft IvrofttAgo b m> extnutrdl- 

' nftid)^ t<fuclouA «« to dini* to the lippt and to the bottom of the inverted 

^^pmtini oif . Rrtfirati^m. DyvinKni ia alifr«y» Fimmt. th? m|itniliori 

^^bymg horn ^ to 70 per tcinutc, necorduig ii> the aimi o4 invdre- 

^^HU ftsd flili more to the wtvaxty of the totsmiA. *nd the pleuHlie 

^^^B CftOMft ft |;iwiliiL^ rc»IiUft(ioii ftnd shtdbw bieaEhlnij. Hmti ^nd 

, Aibft. Tbo pidw b full ftod bounding, ftuf df tfi ty^hatd. fti(ith'*iy 

liffw. Tlie pulK^emprniturr raiv> nvid 1)ir onKlJIfoti uf thi? htrnn 

•ouadft wc imporlaat factors in prognoua. // ^ ^rarf it acting prcp- 

itif tki puimomary ue/md wufid ti tifongly atf^rtiiMffd '^nd its matidd 

^mimJiem cr abtau potrtis fo ri/^hi jukd titrdiac dUattitiim attd im- 

Ttn Bli>od.~^In pucuniuoiii IrvtfKyiviis rudjchly luc^ftuiea itic tcti^- 
RKil ftelioii oi tonemui and retisiftnoe and It* altMoa b cminoua. 
The mn^ mimbo nf leunK^m is a.1xiut 55.000 p«r cm., ftnd cotuiti 
betftten ^hOoo ftcd 50.000 nre not uncomcioa. The ugnificftoce of a 
fftilurv of leucnmrajt is uimnvhfti diminished In compllfftrinj^ pneu- 
DiQ«i«« Mich u tfaoae uaociatctj w'iih typbold or smtllpoK- diMftscft b 
wbkb the Titftlity of the pfttient rtt%y begmftily lovtrrtd, Thttfuec^ 
tyit ifuni WfiHrift rMthts nvrifial \t-ixhin twv vr Ikree days ajkr tHHs 
«nd iCi imiiif ^rjfjljnftf ju^^rjfi n/J^ ctrmfiHohora. The Uritu. 
Albumfnurtft U nunmoti liut U mmUlr of d^ febrile type Kohifdfng 
prompitlir with the tenuJntfkin of the nctjve pioecw. Thd itrmofy 

* ftoak dbioftl cJipcfieftee tlw author «t>uld ^dvbc >pc<kl care Id the 
lobar pOBomo&ia of amaccd or ^panody eured lubcteuloiu casca. Mi»f 
el ibeee Mp«nnee w ddea e>*llapM aS\tt a few dap' illncM and «ltM >t 
tha time of tpparent «fld*^ 








■hies vfly S0t be poKDwfy oB^poiu 




mttH rvflj fputvni ^>pwi or the 

"* loMl teQUtivd)r bcCoK thc«t cvidncct ipfcw. cms Id In krv«l 
br lt> AW and ilir iB^^Mftt ilvni^ tkcA HnA^ta hrnBttd 

Pre p W ril.-^ P tt tti iPok » tn «!3(ii«xielr £iUl dtfctv Asd UUi i iqai 
lo lo 70 or Fvtn $a% of the ouc* AdEeded, Acoanfing bo ibc 
«f tU tn< and Ibc A|G« »■! TiuHlj of tb» bdlTidui TJ 
J« b«tf olJJb cniWHi f ; iiM 4it jAr tAru. itt Ikmu of tod koAiti amf m 

,<v <AniMc 4toajf. TIm tdbncuhyu ei p erfap cc ■ hf^ 
aoJ rccuTTcnl cmc»uv ameiriwt oovc ducooia ik&a pi^uj Aiudka. 
lAftnou&l povumoniA of th« kibftr tfp* U «^)»dftltf ftttl fbaauli Mw>e- 
IJinai p«QtUftilir truukiil- £j»mn« rofidity *m4 arrkyikmic botk 
CM o fffdi n^ ptiUv and rapw^itom arv mwmo Jijpw. «j Afj^ 4re AiVHW 

liB^wmmtti*, Umr kmcMyte etmttt, nmd ituifk^ dcfMvM. la > tdgk <^^H 
privau ptvdre ni leoM td% of &II cvradk^ in grnfral hoc{iial pnJHI 
Khe morulhy will r^ (rum k t£> «%. In pnlinilH ■Urrv Oo jous 
oC 100 I will dJBs* I1w «MtBlu] elemenC io pro^oti* aad U«atiiKttl 
conMi In iIlc ApfTrrdaiitm i>f Ihr face ihai aoe h ifttdiitK viih « lotzsnla 
to uhleh ftU locd manrfuUiionn at sramdarr, an<i tha? hope Ijo b 
dlmlnUhlng lit wmlEncv* and inoouODg ihe niturftl rtibtia^ pom d5 

the jMllCQt, 

BROffCHO-PHRDUOiriA.— (f4UTTh«] potuiOOfib* lobnUr 
pcciatHJiiU, cainlUry broaiiiilii,) 

DofiaitioiX. — Ah aaiU mixfd ir*Jtttit^ JitJniaU4 vUk pr^l^tmd 
t$ixmmla and an inficirvmiiioH httvimg ils srai primntify in Ike JmnteJ 
branckiciis and Uhuhr JlWM &} A« ttmi. 

Bbology.-^rio tpcdil ^nn has btra Ifkimflksd, bui the dlplocoecu* 

■ So mwiy T«ri»lkuu tnut ialo lx>lh pHvair &nd public pvMtitfv iWl 
Mthttrxry figure* bfMioe ridicubui md cur judfpnml aunt depdnd i^nn 
« kaoWudga of tlw ftronblc or unfiTorEUiIe f*^uw« in Mdb 

pOfsaBodM li toM o4ttfi fowd, usvtUir b cmnMtlQn wUli othei genu, 
9ueh u the pTQ^T*^ Mrepiocncci, FrkdUmJcr'a bAdDus vid mors 
lajrlv KIcbs-LxilliT and indutxua badlU. ITic j^crcral prtdispoS' 
ing la^tcn Arr namtulljr the nme at in bbar pnrtimonb [tn \> ijq)- 
75% <^ ^ pncgmoniu in duldtru aic of thi> type anil of these 
thomi I Idkw bfonchitia. Ii b v^ry cammom in tine aged and ai a 
cDm|i]iadoB of aoilc and dirimic cllxuc Any frrELant. a» irrliaclne 
orrl'A^. tlicrttporofuuMthelksot Um upitotion of food panldca 
catu« IT in tfir prfamcv of puhogenic grrmft. 
Horbid Aofttomy.— The fii«1 »1ape isont af inimAc con^ation an4 
th« ca[aUafy broocFuoIittf and alvrolai cotigncion vt follmv«l by a Kra- 
ibsinaus or benwiThiCLc uudalion sModnUd with pronounced devqua- 
smAon <il «p>th«lnni. Ordmahl/ an antecedent broncbltti extendi lo . 
thctf ffruduiTS^ llx bxoficbiolcM bcctiroe plujqM: ibc&WilE jEraduaOy 
koD their conUincd sir and t^llapse Tbe exudate, on^innhly letmfit 
cmtanhaL 'a 9ameda\tn diKlindly fibrinous but. 
ia ocUtilu' couUtuenU thow a predocainance of 
•fdllMUDm over leuoocytis. I'he prt>c<4u i4 
biblo^. ailcciiniE diicfly ibc lower luLot po»ic- 
riartjr; tha hing appaan moitted vjtfa bluish 
bnrvn airlea difpraBirins Endioiting ci?]|ji^Birid 
attm inifrfipcrscd with brifiht ltd emphytse- 
^^^^j^^^^.^^^^ mntoui and orrpitani ^cld%. FualAn 0/ areft* 
Jt'ftf^iH ungy bKng about eiUnH(^« consolirUtlon or the 
alTcded pcrrlJons foay remain iatilaleii and arc 
mnctlcia au niirmtc ab tci cwistUuEic an dcnJe 
ffia/tary M>ni^'t9-^iVHmfWhi. Collapsed avBad 
BiBT be diateDt^l hy ihr blov pipr. ihr lun^ nrr Inrgc- ihitn ncrmal. 
havi; a nodular feci and irip qp scclioa and the pro<cM of rcaoluiion it 
much the aame aa Id lobar fftetmwnfa. buibonfattnnately marr irreg- 
ular In iu |iQlntaold(vc]opDMnt>otballhediacaaeoTdin&riljr termiiialc* 
kn peocncted Lyait. 

Two Cbatf iMrituoiift of Bionchu-pneuinoiua.— TLc diMane 
maybe divided into primiu^^ and ucondiiy ouca. The lormej come on 
I aosiely and tenntaue ta a rule quEle ahm]i:1y. tbc Ulirr are Inv^riihly 
E inhsequent to a brocchitfs i^r couplkau some caijiiaR dlicMC The 
P primary lype k bifrntiust la psifrata over 4 yaan of a^ but oon«ti- 
■^■IC* ftbout i of tbc cascv 10 tbildren. T^i^ piimjuy curgculive fona 
^^Bbr ^ ^ I**^^ ra (9 04 botan or raty tcmunate fawnbly in a lew 
r (kjv. Tbe seoicHiary form laaU for wrrki. 

curiae r inv4 
r« Itctf r 








dutMlivlxioiu.— A^dc frcun the: [cocnl diTinon tato primuy ttd 
•KOnikry csKS. v^i rtcof^lu tfcrcc fcmu of dfsns^, (r). AaMtOt^m- 

docribcd m capolUry bronchilis. ui4 f^). The cot^mvn /m* o| ibt 
dbn». 90^^ of fonru (i) irnl (j>arv bibtmk tlx flfattfmmalH fefvi 
ioTftriftbly «3. In ilic tnilc cocgoUvc and (lie comcooo fbcim. tkf 
Agiu Btc dwayii VMict imirii«d poAichorly and »c«rt;r 4)»m7« in the •- 
ien(A[/iLlaTiq]tKV& Savcln thcninJ>ccunjpsll\icfj[)cuiDuoU>« thci^Vfi- 
lomtHad ^hytiaX tipttvt 9ttikii»£iy ptttmittary iram tlieotttscl,ibo«(ft 
aomrlimrB vbtKnirr, ronfiuiiijj:. an^ ovir nt ttK^ytil wSeh the (legm of 
invi^Kemcat i^ioitn by autopsy in fatal caMs. The naluv of thi 
patbologk procMs npluinjt this Fact by tiioiwinL; Thtl rrm when cott- 
■olidition cattb the «miiilJati of Uic surrtniniiing tivuo dut be »ch 
» to pnxiun a bj-pcTrvtonancc vhidt noskE Ihc pcrcusDon (iftns of 

$jmptoniA of th« Actite Coo^vetivo Fono- -TIU may be npidlj 
fauL kniinj{ in 34 vt 4^ bnun antf Ibr pbyiicaJ ti^jt may br limflRl U 
banh brotlh aouod* cmd pouJblj^ a ali^Uy iinpoiivd prrcuowon ■koie. 
The d^ vt iKually bUaicrnl bui tiot hocostfily od cqunl incentily. 
TAr VAJd fi MiJdrMt oflrA w;tl ivmitinjc and utiwionaUy with Cl»vu^ 
Bto«k* in ^Udtm or GhiU ia Chv a<^ull, 7~A« Jaw runs high aad may 
titrodily mcmur to a fatal irfmmatiun {i^J'i^)' ^'"'i^ '"^T ^ 

rxfrmfly rapiA, cyannns marked, tnmitil duhm amA tfclky foHy tmi 
exfrane. It tfiiiy mttf^ into the commoi) fc>m) of the dncaae or Um- 
inai« ftharpl) by crla^ 

Acut« DUetunioated Bruocho-pncuiDoaift,— Thl* fcvta ^hkh 
v»nw oE th« foni^ clinicians still lonu ''capiHary broochicU" 11 phm^rUy 
an [nfljimtnilian of the ai|iil1nr7 hicnchi. btU, jkbi motii^. a iiiYniub}y 
ojBodalcd iHlh nmi ot imc broncEopAcuiiKniU. Likt iht oUkt 
fnniM ^ fmnfi dh lumUty, ftJif and nsfiircti^m an nfid. proittalum 
U miwM btii fwt imrnediaXt. iytfrw^ itnd cyctknu are prnnintrU^ Ih4 
<9Ugk it ifwrt tkot^k not rk-irfiy fain/*i/. but the Itmptratitrt uau- 
dlly tuna itne. Tbr phyiacaJ al|pi» caosiil chledy uf (be mb'^itrjjiiaal 
and cMintfr riFc«> f^ncmily dbiribuied. ftlw>>v biJatrraL antl b«l 
mark«l [»atttricif1y At ihr htun. jTAf ^fnmjwn iv^ ir At^frrcji-ftdAj 
^ tten tympiinilk, and tl>c ducAar vrdinniily mru a ahcrt course of a 
few day« or a wrHc oir ua days «nd (crminata by I^'sij^ or mtrpa into 
the oonttnon fonn vf the dlsraA-. K^i^nvoy Ja the rule 

Biowcao-nrxcaioiiu. 14^ 

S^BiptoiDS of die C«maoa Form.- rAtf #4/<f fj jlmi^ M«r JWfA I 
^wi wiih mre «Kcq)iiont isrikmgl)' p^friiU/ii' ufun 3 lo 4 d tg ixt), j 
w ww f iiiy n ff^gnntl wit] ^ammUwru m iAif^vn o ran faiiW nvnIL 

pait^itL Tke nsfiniiam is rapid l6o-ic M erta ijo in urmv cuci) K^ri^ffpid 
«id KMT Ic noted «9 a /nmtfmAtrv fyn/^^ Avn brlsrt tkt ftunk onset; '"Vut\MJu 
frminaihn it flUfJM «iJ tkoriJy tfc/mes ertrrmf; expeaumtum u 
«l«ud •« cMAviVh Qtt'lc'''' bcCoGcXS mdrjfcrJ I'n oi/ lFl-«r* rvjtj, aiicl 
JoAr cMiMiM«n maj occur u onv of Ihr i^ncinjiJ rtictits In nre 
iwUncia uTwab cv b^j noutUh?') chiltbcn may ihow & low Ircnper- 1 
itim. Tfa« pubf may n»di aoo and » aii0*jyj ra^ and lome- ' 11,^,4 
dmo irrrgnUr ihe rij^n* af jutfui/ dysprur-t arc proncutuni, the nln! ^"^'** 
AMi bctefi acllrc ukd tiii>}i'tr%J<tTy nxctaon oJ tKe lower inlcnpMGi Duvndt. 
RttrtiHl- (^ficfr^-Matifliii/ dtfiHrAonc/^j msf b« jifrvnr and grmily 
co<n|ilicfttc llie imtmcDl, fliitulcncc tad cxhtiutinK <!ianhcra <,..trtt- 
«r |wnbltni tomiting inarivatrt by cough biiitig iJ* fn'Wl iroubit- 'iT«tSr!!», 
aomr f utori^ Thr uHiic Is frZitile. bdug ACBiiiy. hi^ cukit?-i. contain - 
iajc ri&cictf of anild «nd pcrhapa a tmcc of ftlbumm. The ^rdinnry 
nnirv b from mn tn ihrrr ivrriiD and ii umuEly trnnlnain hy ly^t. 
Cmc* Muy tKntrvcr b« pqroloaccd for lira or thm monlba or a chronic 
broacbo-pMwnoaift may taoctfd thv acut« form ind oflfn drvf]ap« T-*mLn/ 
iBioalubcfcokm. """^ 

FliftUal SlCm.— These uv primorily iA« 5j^fr ' -'f;>' 

Wii, iIm okhI cbaAiTieriMfr »1^ bcin^ the )>ii!j' I'l riLjinl 

diMdy utd prvdomiaftntfy orcr liic tower lobes in the tntpcncftpulnr 
«pttmL TnlUir \nbsu pnmnvinfji ihr Wt Lrilv h imiiaDv rhlHIy nfTrci^rl 1 rii r^Ut 
lb04t|^ bolh arc involvctl Br^nchic^ rSjfs. dry and moist, of a larger ' ' ' 
uid ceanfr ctar^^cfer «jy notfr 'A/ ;^i*/r trarirUi and after h variable 
period €ti^m*i p/ npifjo/iiffi^JkVn jna> opprar *jwt ^caitcrrd ircu or ^ 
note rvdy praduoe »tcoMvc oouolidalioj:)- 

IiiapectittQ- — Infptcifo* mr»l» rhe Jnriu of ptrfmtuIiUneu and fb ! 
pulBoaary type b indicaicil by the cvi<l<-nt 4ytpna-^t. haromtig cMtfA. 
lU^I M marlrrd /v^nr^m ami irKfiiraitrry r/r^tiim a/ jA^ f/nfrr inUf- T»fit>fLrv 
if^UJ, PsipcHeit is rK£«iiiv H '^ CiAifr^ifitv '>/«, fre^iiiw ii dimin- ^"^'^^^^"* 
isktd M lAt tUtifrnmnPtd bui may bt imrraW iff <W "crnhot/m j^vm* | 
if cmvoLidalioo be lu^denily cjleiui^c Ptraujun Is wroJow M ifctf I 

tfr J^^nny Mi iA( dbsmt^mitaf t^irtri;^, Hhilrin tUrt-rmmtm jiirm uelkftd *''"*- 
^rmt^t ""^^gfrirf ft wiftirt way iUlmal^ it^h hyprrrtitifuintt. Kurtbcr- . 
Rkon, (nuift a»M nay dlwppeu- and napjiraiT from (^> ^ ^1*\ 


EDKAL 1>1A0If«IS. 


or hour to hour. Lighl pemuiioa thoM iamiMf be prxtiMd Aad 

It rfiould be mnembcicd ih&i coniijUdftlicm ucv ur ficK mad <hkij 

ci^dcot {n Iht intcncapulv spvo Mve in thnse itutuiccs, nMiilr lutcr 

rikUr. fn vhlfti thf^ lorsil^jidifoa U uirrrSriT ^n^^ spiral Aut^tJSaiim h 

by hx tlic mcnt ir^uaUc fifixcdurc. Thi tkamderi^U sigb^tpitmt 

rAU$ art rndtni. avttskaAffif^ pefhaft hj tkfir cm^m* brfikftiK ^^ 

artAj cj imt/fiii^ \w£ c/fndmfiffn &md Monk fit aiM^MmUr hrtalt^^M 

may nakt <fnstiluiaHM maHtftst to tk^ mr tft*M Aomgh iiisn^l A^^| 

I f^rmuimt f»trr. Frfillim tciumU nir nn »d ll rhovU iwm be kt^ 

jpMten that att sipu m4yhf UikiH^^wtrim ftrttdd^pitt^fifM^nttlim 

, oMimoNr w 4^b£^rm mJv i<hr»uf fc j^br tut r/ <ryitif. ind fwibmnofc. Omi 

■■ lt/' cojfj rr/ hrimtho'pntuMi^niii Ihf paJitrti ii ho titJt ftr a limfk 

bf on^kUit V JkifA 'kt Jtj^rr may simi/Li!r ih itt tnHy stagt «r may dtrrtSy 

S^cosd^ry broncbo^potiiitionia it a rommon evfat bi cctlftiD of 
Ihr irut4f riaj)lbnn&li. npninlly iTim^lrTi. K»rlr( fv'vrr tact dipbUiCTn. 
and uatoTiiiDaltvTiitniaLcliuiiufiDdsniilococditiaifl. Iqth«htkJ^ 
It* cixmc xaof be mtiiious ortd liclcmg in Uw fnuik«v dJDJcoJ wats^^ 
filiations, /b mcojfr^ ufk^ xatUt fn-er it xi icirtrt oed piou«i;lifd, in 
, Jiphtktria «xtnim»l)' latsL In Inllu^nxA an* niMtt with two typci. 
UQC cxtnandy brief, Uie oibcr pn>lnu.uJ uiil scvtrc. The lalier fom 
L0 prcuL'ajlr liable io kavc b^biin^ it u ptrsistntt (pumodic coDfclL 

CoitLplicitioiiK.— irpo^^vlitit u ilingirmiiK ami tnublaomp vttm ii 

(Kcjn. MenmjEiliA und ncphrirb nre rnrc, tubcTCuloaU U oot nncvB- 

. mon »ni1 U unclAu^inlly oixm prlmir^ Endocarditis ift fottUDStrfy • 

dmical curicsily. Su|j|iuni(i<jii and tbauM kmrniiLiri mix tmrclj ivcn 

mw in afipintion and drgluiiCion cum- 

Tennlnation-— NUny cur» ur prolovign) Utr nHuith& wEih recur* 
firij: altacki aitd some ultimfttd}' n>^over though manr pro^ tubetvu 
Inuii ard nin Ihr fnunr of a chmnic nibr-tailoKlii or of flbfcid plithkU. 

ATELECTASIS. Defbution. - A condlilon dk4r4<lerii«d by tool- 

in^ or rrtcn*iv*, icmpofiiy or f*r»l«rnt. Ina^ of llic pulmonuy ait 


Etiology. —AniJc fmm iielfctasis in tti« n«vr bom child recuJling 

fmrn etlTvmE nvakncjH or acluat obxtnicivin fri^tD mrconium or mucwn. 
< tbc conditk^ i» csKntfally Kcondary ti> oboimctlan of the broDdii, ki]tc 

or iffiili. S* bn^flm-pnoumonift, ob^rntftFnn by lumcri mnnbrui^. 
j fonijCQ boiir), ui ihi; pittmuri; of p^r^itlhs ot ciudatd^ i-c- mcdiutinaJ 

or pleural gro^lh^, p1?tjral HTiuion, pnfumoltranx, fCB<^7 cnlugK) 
; bean* ptricardial dhuiiHiH etc Sligbi gnuSn naub fovm men 

€o«ai«noat or vas umos. 


flqunsooj u h BcIcThticb, cnUrp^ tonaili or m dcUcatc women tiid 
(^tldrm, le finrvtne c»«ii !hc lung i* mmifirtl and pcrtiitcni aipltf- 
tub Jadi ID atfopby or fibnob. 

Dlignotit.— T'** ff*§ttt€t oj Oft fi^utit <tfuK. in^pirator^r rcoittion 
of kiienfanft oi nduiJ rtlracliunt ubsaiC or dbiiint lubukr brmtZi 
soiioda tad corT«f>ondJn£ fremitus luikc the oondition d«u- lliwe 
are for the man pirt ijlonr nr hiish^tt flrcAs ihmigh in r.ii«i f>f bnirutio- 
pBtPttOaift deep invp^nlbon may coovcn ibcm into noby ones- Tbc 
oeadHloa b M gOMnlly VHmncljin- and sohonUTmlc u lo rvquiiv tu? 
CKtcflJcd ADtkc bar, 

COIVGESnOll or TU£ LXJnGS.-Actiw congMion «nd tb* 

cdeonA will be dlscusud tmdn ihis licad 

Active Congtttion.— Thr iiLbabtton of irriuting lulutnncpi chiirtly 
raport Mid g^M* And the primary »Zdf[c of fjcicurionia arc the chief 
Eftdoft ie Ihr prxltirtjon cf an nTcnittvp- ncii^cr tnnfinTinn and it ia 
so poacrallj hut a Btagr in a dominMiii^ dJMMc (JTL.r^rwi itA htadjf to 
deserve cxlrnd«d dcscrjption (Src lobar pnrumonukH j>. ij8. | 

PbbJvc Coo^citioii,— Shaf|Jy dnvn linti briwrrn olJ^I^liLli^^ 
■Dd hjpostalic con|cc9tH>n and bctutcn thcae and pulmonale «dema 
■r« uDfAfiunatcly UrgrTy confined ij> thr aiiiopdiy mnm Beivmi Ote 
hra \oTma thcic b lilUc Dtcd d dbtinaion fur b^iih irbc fitjra an 
obcCnidod dRUklkv vrhMbcr from v*IviiUr r1tM-:L>>\ :■ ivl iki-rird 
imjooidiuai. '«—"*■, the pmnirc vS lunaum. plcuriiK i ipcm Anlial 
cacudaie «r alxlonuiBl dbUfiUon* co- from c<?r«hni] Jmjvui. ClicicaUy 
(A« kyfttMc It^m Jti r^ipovfJ to ihr BrnjilE obAinKiivtr ninguijun u 
«9CMi»JdW Ha fvnJaflWfU «/ profound <,thoitsHcn espccutUr such as arc 
rhanriprlard h^ the t^ph^M vait. Ic. U rrpr»rnu poiofcnind jTsTbc- 

tmjhmmMt^ at f*^J>ntr4 kt Mir otdin&fy eitema ttj the lua^t atitifiatfd 
vitk fatdvt tonj^ititm. Tbb bUei hxm b a icmiinal <vml in 
imany diic—rii and may ocrnic suddenl/ and without wjuninj; or 
oipcrvcAc upon pmlmigeiS oui^ilLin^ Tn ccniun run it EremK to be 
pttfdy losKanfc but £n KcncrvJ iu ctiotojry u Ibal of the aaaadald 

Hortnd Atuttomf.— Lonif tcnilnucd paauvc cunj^cetiun may piv^ 
duce breihn mdunlion, Che organ boing denae. bulky and nuM bravo; 
ica EBfulUries mx dbtcbded. the broncWte^ atn.] alTn>1i fiUrd wiih epj- 
tbcyuai, blood ccUt and pj'icment. and tfirrc ji conncciivr tusu« in> 
Thb fT^rm^u npednUjr chc oluiruftlvr cnnsrstjon tfpificd in 



■KMCAl. mjunaoctS, 



ittCompcDHtn] miusl kmoo. Iti llv Aj^c^sfolK: /ptm the ctigiXfcnMsl 
tt iiUrftw «fid portNOi oJ U» kmg Mnutinui oirien. If thc«c ucu 
m ciUsisiTt ihc lam ificmUaiieM fa ^pplkmbk. /■ «init« Ihc bulk* 
lin^ b toddcB aad l>ie f<i*n7 ydlow « reddbh 4cnu9Q i&&)tn£c9 Uk 
Intnnltlll Hmot tni\ fUh ihr tit pavs^n. Any of thr forms of pavrrr 
Gon^c^tjoD OUT be pcrdjmuucllj tmiUicnl ttil an tme^y dJaftril, 

DUgnottf .-^Tbe edUmcT af a cau« iA thf fim link in ibe di^ 
otu duin. Tbr s)Fnii)Loins of Boitc am|:»tkiii of ibc vcvcrcr fom ut 
fkscnbcfi under pocanoiiM. Tbc aOder tjpCA of ill v&rktka at; 
]jnHlu<c tui lilfbt nbjcaivc and objcnivr BymploRH, In cantlK 
diic««t for amnpio the ocAcljtion nuy tkot AUn<t notice unti] ihert ii 
cnarfc^ dfipiKna >iv1 a Mood ttmktd *puium containifig ihi^ ppcuUv 
pignocnt bearing ccLU A carcUaa pnctilknKr often «n^rdf oraloob 
kypcitcrts uniil it hht rtachcd • pneumonic tiagt (ipknUaiioQ). tcw 
frequently niilil fonn& of tdenu nan nhjtli ruy be Umnsitor?. Lb 
the tcvcrcT fantu) of paJDTC conjccftion djlpoo* And <ft/iow an 
|irrarni i^nd In maEifd nlema we ncrMfvc, In atl ihnc te rrjiriefua 
0f that mm/frntfU pan ^iir viAi^ itn ana »Hivfir«d- ^Vnniluf ou^ 
be diminjfhcd or incrrued utcordmg la the degree of ACliut oooMUdt- 
Ikii procnt 7fif /^A:it>rMft mile may U hyf€rrt39it4mi fnm rrfttJW' 
iHW dP Afif ^Vfffli «Bwnf«torwti. ^lurWiaA^ mjy Ht«»f Ad/jA. d«>v«a- 
LAni dAjmi or Ju^iJ^ WaiAnil Uf<iirjtflf Jc rA« ifaif< ^f «4iafejJiM> 
JA/ frtstrtC4 ai 4fr/«rit^ itf. frwf ^tvun/ii^li'flt, /F4i«r. both «hy imJ 
moitt w prraml, tbrir |nT<h antl quaHlj ^"aiyJn^ with Ihe p«lhologk 
condiltocks^ Ih adenm tkt ttti^j^ciiw symptomt srtf vptd^y pf9- 
MtfuiNftfdL the ipu^a profusr*. iwthy. scrou» or blood atainnl and in Is^ 
JlsmDiAlorT cdcoua prcacni the ''prune Jlucc" appearance. In odcoia. 
fnorrovor, ihc rtica tre more hquki. the bnath soundi and voice coo- 
duttiod Hj|i^rsM<J or freUlr. Slight cirpIlAtioii &l a boac at s ucpbrilic 
nibjoct, or any paiiont su^crinj; ftvm the diAeafla aflBodaled rilib 
{laxuvc rangotion, dnnuids scrkiui attendon. AitonUhmgily ihaip 
amgntioru may Bocompon/ olufurc apoplcidcd tmoMOCLOted with p«- 
ral^flia or Iota cif contcbuimcw-* Thit effect of cardiac nitmilatfioD 
or, in bjpoAtaAb. cncjc altcniiun tu the nocEatti> ihUling uf & tAa^icni's 
poaition tDAy npddJ^r and E&atfc«^y djmitifcfh tb* involved aceaa, the 

a In A case ivremly obeerved |«o rervbra} hemoTrlug** nf ihe iOent type 
onunad wltluut loa of caftidoiuni!«« oe povH-. iht only sjmpTam being 
■iidden piJlor, mrnnal confution and in ilv aeomrl iiiAtL mntirnt mniiTr 
4pha*la- In tad) \herc iraa mvkrd patoK^im ojigcstKm luitng iin 
abgul El hDurik. A third hMnunb^Kc Krn ^y> utcr pruducnl a^cng«] Id- 
■Ebai dealh. 




Utter CDrfthw lioig often due to <ioc hjoed pottuic in xnile, obcie. 
cocbeciic or pfofcModlj bnvmit patitnis. 

TUBERCULOSIS. (PulnLi.njiiy \MhiAA CJinhui]i[.i[.iii).— I>e6iiJ- 
tiiUL'^Am imjtdiMn ^nuf taustd tty tk4 iutffcU bacaliui oj K&ck, 
wamtify tknmit, rmrdy «««ls. tkarMkriud by the farmatiun vj lu&crda 
«r « diStm Hi>«r«lMi »/ to^ffCtfiobs Iwuf and f#nJ«Hj ft? ukfmUfim, 
filnsii or £9U^Uatmt 

Dislribulioo. -It ii A imiveranl disease \uitiiij: pmctiadly &I1 r*cc« 
4iid fWTj btitudf- In tbe UnJftd SutPi ainnc it kitb ai Icui T50.000 
pcnoctt cacb yev. ftncl (h« Anmul lo» b poUnUnl wedtJi hv bccD 
niTfiailtrl «i 1500,000,000. II <««U lh« life Eiuvr»iK« compcmifs ol 
AnKvks at loul KIjxto.ooq ufiuu^Ux- duti u the ileailis ocizur chiefly 
M «vlf igw wbcn ttrw pstmiuma bJive been paid, i1 cocoliiutts the 
vmm of llidr gieMot euljr Ion, Domatk KiJmlt ftnd peu, mch ns 
CwUc, F«c>< KU^TicA ;hjc:^, rabbiEs And Dnookcys arc extremely »iuccptlblci 
honn, do^ goMt tad can lev lo. Cold, dRinp, dciutd^ pnpublod 
dblrictt auffcr bxqL ud dr^ 4nd hl|;b altituJc rr|^nA \nM.. 

■forbid AlUitom^. — U a pure miturr of tubercle bidlLi bf injpcteci 
in ihc tuwwa of • m«c|rtiblc iniinil it pirxiucm lubeitulosii, Fmm 
the tvbemloia Iijmics the xenn oin be recovered, i^wn in puze eul- 
nife; vi^ihi usrd £iv triAcvlftilinn And to on tndeilnlirly, 'I'hiA ahtolutc 
prouJ oj ita iufK^iviu iialuir maio the poailkin uf those fji^ilm); tbc 
"9«>l »lul« p'apM'* uiU4«ilabl«. CJBtfff^a 5i>(Mf«««f to Irtaaihhon. 
(aA. GroupBUK ol gcmu in twue by mifltipliattoii And ibdr diatHbu^ 
(ioB by tb« tymph cvnct (b)- Tbe fumatioa of epithalidd celU. 
aibmii fivt day* ailrr inocuhikin. by mullipHciiJon tnd by mclAmor* 
pboili of Ike cellf of Ibc cai^llAiy endotbclnjin o/id ooaoeoive thsue. 
(c>- Otnwmndrrini; of l«iro<7im ro (onjH of fnfcnfon nnd muliTplfratlnn 
of DSOttAOclcu fvnro. (d). The (omistivn of a m^rsin*! rclioiluin of 
ceoBtCtivf iteKfti <«). The produclior of tar^ rpIthdloUJ c«lli tov- 
lAiDflig fo}B Ibur 10 Iwc&tjr oudd gruupod ol the putcs or peripbcrj. 
TkflH gMMf nttr m moBt oonuuoa in lupui tnd m gla&dubu aod booc 
tufaercninds *tid tbe Bonr? i^mnk dacI hIcivI} drveloped the pnvm. 
Um JCfCAtcr ii Ibeif number. In ftcute 1e»^n:i ihcy tit KBill and Ab- 
sent, finr uc thty prenlUr in tiihrmjlruiii, Mn^, fmmd fn oihrr of the 
giaaulocB«ta tucb a> ^pbilift. Cojcoltuii end SikrvJU, The liuoigca 
ihgcribtfd tend inevtiAblj to deviuiue the iffcctcd ttwue and pnxluce 
ATCU of ocDtnJ imgUAun neuDsk ^nvcrlbs *JI «mictuiv» into a. 
ditof baanogcaeoui cubiluiCD^ Thi« may l>e extruded, leuvuig cuvi- 
ikt ai ffttMtr or laas rixr, or. morr rnrvty* (alciftratiou nv%^ vs^tv^- 

A Q iiTin«c- 





ind&of ca«Miiofi ttd olua 

TIm apCMd of lofectkii.— )i vill be it«ditr tmdcni«od llii 
lymph (fatritiudan aviuiA a lirnr ufettion «nd bfcctioa ilmiq^ fhr 
bbod ilccuB ft r^dBj dcvclopbit t^d fridcty diMccalAAtod process. 

Stfalocy-— KaO: TV Hrbrrvv «rr lo i <mAia 4^Vttl Ivnniipe 
but in \hh *ji/vn.ixy iLc Irish &n(l ihc Scacdiasiiut* tW Joilan ami tbc 
N(!gTO Khovt K heavy morUlicy. S^r. lu mddeace ii ibool 
Id iLc t*i> scxei. Agt. ChildiTTj «uv pocuIiRily pnmc lo iITi 
fiv |eI«d<1« aiu] booe*. After Ibt i|cc of duldiiood Jw tunjgt mc diFeif 
*Jfc<trd ftnd stiact^Ihlltiy dUnfakhcv nuMblmhlj Jtt thr »^ of jcv 
Oeeupaliwi. OccupolicqtA iavoKfng caqxvuzc lo cj^toks in tcfupet- 
iturv« dutf «n<3 duApocHandlitincilruii£>vonl)l«. Wcitot grmcbf 
gLua vr neel <ir londlliiif fun show m bi^ mortality. Smtitarj Cm- 
^Hiams. Lock ol nmiMne^ frtth tir. oreniowdiDg, fUtb ut6 pi 
cahAunum ili? all predtHpaiinK Uttaa, Amonpl tlic Uonucftl 
all con<iJriunfl u« favoraiitc to lia dcwlopment «jt4 UauBiIasion. Pr^ 
AtiilcBj XJri^MUA. 'Dibffciilotic ff«<|u«nitj follows diTooic dise«fic 
of tbc tODsb. admoidt. ocstcocd coldj^ bmachtt-ftfinuiioflku. Ivba/ 
pneamonia. pleuriiy* mfluenu. o'^ailr*. wtLoopinj; ooufib atid cnur^ 
colicis. uid fnay cumpliuilc diabctcj*. Aocunaiii. bean disease. kNtmiotor 
■laida, tckroaU o( ihc liver or chronic Bhghc'a dbaasc^ any amdkJoc 
in iboft xvdudng rlialiiy and r(«j£taace oi undlng to pmrmt Crre lucf 
oqittfitioik. ImjttrU*. 'i ubcrctiloaip of the boocft nod joints and cfpc- 
dally of the v«rl«bni and hip Jointa in children u fns^uently ascribed 
lo mjuiy though due t>o <k>iihl to a ptr^e^iiD^ Ulent bi<cliOD. 
H^ndity. Direct Inn^musi'^ in oteiD ii probftbly extmrjd)' rarr. and 
heirdii> b htjt anoiher oame fo* po«1-p(uuita hii^Laiitaliua of genus 
tipos » fjdluw ioiL The tubcrailoua no^er readily trxnimits |9cnns 
10 b«r otfsprfDg and a ocgleft of saniiajy prrtuutiona in any Inreescsd 
bouse is peculiarly dangerous to the chiklren^ The f^nns may nemaio 
Ufect ID the glandular i>virm Cor an in^lpgniie period, a fifl undoobl- 
cdly cx^ining the iticreascd adult moiuUty fron tubcrcuJuau in 
familica showtnfl Uie umt, Indmdttai yftdiifionlitm. The "habiliM 
phlliiwLua" tiaa loni; been leoogoiscd- icitAin inditiJuals bciog fnun 
t»flh leu reHStaat to the fcrm Ihati are olhiry Small bccc& a deli- 
caEr cDciplexEanp and a oonuadrd di«t. Long swer[uog luhes, large 
[iuiTi:iuA cya and silky hatf nrc fc<Lind in one type; a muddy aimpleiion 
Ht[h marked Ecndcncy lo gUiidiLUr awdUn^ acne aod vfaJ[ eyes nmk 

waea c um aa. 


ihf Mbt-r iy\it. EitnoHla«f>' b««uty- vinusunl FmrHIgmcruidAqijIck 
wii yitn nxoffnttii even bj^ thtf uidents oa ijuniitim often uaooJitcd 
witli htbcrcnlous p rrdiipo ai Tion Tht rhtliln*n of either Type rtpirftrni 
andoobtoJty cues of Ui«ct rnfcaion oji'} nerd unusual auc along 
hfiEMdc l>*<*^ fUTing iha. they may grow up lo manhood itrons and 
wdl. «nd flk of nfiE ityr- 

Vnhi%BflM Sit« ol LMlons.—AtmodE uty portion of ihc body 
tOMyhe involvi-Ei Ihc lungs fncMt rmiuenily in adiiTti. tlir bono, lymph 
f^DBck ukd inlcBLiDC* m childrmt wl^ tJic pcntoncum^ kidneys or 
bmin Ruy be involved >r uty age. Secondary itivtJvrtnent of the In- 
loliDa b VC17 conunon ia advanced puImoniaiT lubcrciibu*, 

Modts of OnsM-^il choitid never be forjroiten thai tvttriy ttmy 

mmS aj htatlh* As n^rds nctual onset, ii rnay b* acute aiiliiiry and 
vldtspivtdk or wboQy glandular, phnitflic ot imcumcmir. 

ACUTE UtlARY TtJBERCULOSIS.- (Aojie tuUrcUosis. 
General difluve Hiberculmi* Atutr 'liitfDimmwi nib(frcukub-| 

Csust. — Inu^hluciuiii »f tul>«iik KtLiUj. fjuiii a Ultnt vr aclive 
gisndular, <i«stuii4, or jtuEn^oiii^ l->t:ot^ itiu> the UfsnJ tlre^in, 

HwUd AoaUfuiy- ^VjMCtd ifjuw ifutHTiiL cLin^ ttt on acule 
klxik nicction and n gcntni disEiibuIion <4 miliaiy lubcrdcrk the 
Iciljiu Id the lung, plenn or brain ptederminaTing snri the prritoncum 
Of mort oAen Its diaphraf[fnatk njrface bcinjc frequnnUy M^ccud. 

Sf ui|iU>iiK.— TypMdal F^fm. The oasrt mny hf jcrodual and 
EUOly i^ulatc tyvhu>d, 'nc fever rises pftduoU^ m jixne rarely, 
dksrplyp oacI 10 s vorlslslt degn«> roj-fo^' F< b«ing cximnMin and 
■Mifde CKics rw. The sjnipLuins njaj br iIjobt uf lZi« "typliuld < 
dote** but Ae fcdloving sre p«omincnt<OAd ^<>iiJd b« carefully noied: ' 
— (s). M^rMfy MK^tniui ApiioJAmj. (b). Siibjafh<e and ohjftHv^ 
Jytf^MM. (c). il f»/«d tranJI ^vJs^. (d). Ctha^uJ^. (c). SwtaU. (f)' 
J MHdUe, 0JBDI JHlrfmiltm tit mt^tt rmfrtfciitrf. A owtfunour len^ 
prAluic uiay be (ircscBI (or aoiuc da>s j'liijt t%> liic iJpvriopmniC of i 
MmsMMfj, t'suUy but rot invsrisbly on« obsenni« fg). amgk 
yoprodudm or slttBded by ptuvlrni or luuDT'^urvlenE xptitum, {hy 
Tiikfofe tesUk bMA moy ftf ffanti osriy. more ofien hue, of, ic fW ' 
***""—_ be afasMt ihsougboui. (i) ffrrpts kAialh. H), Kaffid 

P&ysica] SlfBS.^Al tor 1^ sre shtcni or nnl/ bronehitic m 
duuactrr «Dd for dsys or weeks ciay be Maul or mi»iti»liii|^ 
A ontdvl oianunatkin mfty damoiutraif the prt9cc^c« <A. «KU 



la&tCAt PtMHDSn. . 



AW MOif «milMf ««tf jd£m/<untf Mrfy sitm. la rue inttaoei 
pitehM of <ouolidalkn ue cJnrfjr daAocd. Tlu fi ri arywgtf #/ Ik 
j^fouc Hocrj mMcA iMr Ihftn in typkind, ami i&c ^me nid^ be mU tjf 
EMkk's 4i09ff-nat9im. WidaPj $€H H obMHt. 4x1 ihc noob in 
I quite unlike Unbt of tj^jJuiid, Funhcmum ittE pulmojuity Byn n p<o ai 
' we sOKkbi^ preilomiQiat ewn ia tbftt tcatc fmcnl forai vrhidt pt' 

Course.- Six to twdve vedu. Proeoosif.— Aimoai bivmiiiblj 
UlAi though ru«Jj ihe tcnU ^mptonu tubviiJe kvviDg » prop««l« 
but Umitcd loiaD- Comment.^-'nie gtoeal q^pUxiidUilogy of At 
fflifnr it that of ^ ncuEc intoxkutkn with diMcmiTiiLteri m^krr 

and thor factx cipUln the Hhairnre of markr^ ph^lrji] sljpifl. 

mar be wht^tEy {lulfnon&ry '>r ^rcdominanilr abdomioAl, l>iit 4 ilhriikB 

ACUTB PKElIMOinC TUBBRCUU>Sia-<Phi]<yi floiiik.p|. 
loping ocnAunpiitm. acute lubfrculopi^fuiaonk j^lhiut). Th« i^k 
rdaiivtty r^rr dL^nv r^iircscnticg net t^rr z^p af ihersKMof jiolaDqn- 
ur lubcrcoW), ItbuAUAllybrofidio-fwcnorbGinCcirn; rmidfi fete. 

The lobflf form may rartly timuUie %n onUMry piifniicmia, M 
M0 jSnii tfntMonly a JkuJory it/ prtviomj ttfncjj or jjfiw 4/ M JuJmi. 
In UicM cuec the dotmctivc p r o< «w h ofieo 
rapid &nd extreme uid the author fvcjjls one ui 
nfhich at autopvy the njthl luoftvu found to be 
cntin-ly de»Ri>cd. Icftvinft » hufe cavity; tJit left 
bfiltralcd and hypotrophied to lucb aa txUtit 
u lo forc« the HmtI to The tiptt and produce 1 
coaorntnc dcxbcnrdio. Intfte«d of * true crisu, 
ieplic icmpcrtiufc dcvdop* with s^rratt *nd a 
pumlent JG^utum cuntairiEHg tubtTvic liuiLU but 
In •&m« insiAnccA the procen »itb«ide». beoomce 
thronk arrcj may even brcome anmed. £or^ porHkt dia^notii ii 
tmiaUy impmiibif. 

Xll« broac bo-pn^iimMii( fonD,itdiancterJzed |Mtho|()gt<ally by 
bn>nchi>-pneuiiL^'[iic Iciioni and ^huwi a tendency lu fu^u> oucatloo 
and cavity fomoation. It prrMnc^ tht fvmpionu of an oniJc Wvmk^ 
pmmmcmia JoUawtd by Uu $ipu «/ ftfUt 9biTrp4itm. ftdlmmury ittfitifa- 

* Aa a nuTifrr aI f«rr thr MnfUBioc oJ lyphoiil fef«r knd mUiuy lubtr- 
eukati n^Fd but nrr\y nmtr rtvn Lf ihr dUXDAb bfk tJu usistAnot of ibc 

► la i'.-Tii»,»*Tk 




Ham artd cavky /pmofMit. Tubcftlc builli may be ud uvunllrMV 
pntcst eic^ l»1 tiieu- appanna may bt ilvbycd. Hcmopt^ omy 

nmtr and U H>mciimei tlw £nt *t«iL 

Coaiment.— Ill both ike bbnr and broncho pnci^monic fonn* ^ 
MCQlt ltth«rculmb ■ iklaycd diagn«k b nJtrofli Rlwnyi ixvnKAfy, ihr 
m<»t cardul qiac*tMnid£ u (o prcvti^ua be«Jib tiK) fjjciily bbtory may 
yield no iDforatttion. »ri^ ihc A^-pKtn^nrtr ol lubcrck bacflli tnd th» 
iigni of dcsuuctivc uUihialion uaudalad m'tik hvctk may be the <iiity 

IvbcreoloUB liiiTBtr of t^ Iuar chunctcriivd bf cbronidty. \-knftbEti1y 
in fmrity vtit fnqumi liiKrmbvikiruL Asfdr fr^m JndJvMuiil mlu- 
Mice, iu UnDJEuCHO b tatntrf or dcftlb <Icpcnd» ufNA ihcprompi- 
■m «illi whifh a diifEVkOiU i« ixkadc ukd ntton^ mruuKS ifulitut«d. 
Wiboloelc Aiulomy.^Thc Iouods AnoHmviJy lb«e oE a cbmnic 
l«b«mloU0 bKificho pncumonii; the leiniinal bronchioles JUid lh« Alve- 
oli l«inglhcsnitDf on in^ninmalion fonnbig 
hctoi of peti-braficUd pntumorh; aubtC' 
rjiinil chxn^ ikpmAJng upon Ihr aclivily 
of the pnxte* and ihe radstann of tht Indi- 
viiluai UvotUy 4 funon of u^^At rrcultt in 
ulccratko and ovity foimiihuEi, Favor^bk 
cucft recult in Hbncdis, cmpfuUr lintiuiSon 
ftn-i UTC»( more ^ifu^n tbvi te ordinarily fiup- 
l-iSi«r.r<^;;Z" i«T;«! PO^- iponl»iwo« r«ovcty ftom N.K<c«jr' 
SaKm^'l!ttfEMBl>n«'* *^ "^*^ mhemitotfR iJrinR rommfm, as ihown 
by ihc [nat toarttm ^fco^lB a( haiuc onJ 
almxul rantractH spioM, pcri^bmnthijil n 1- !<■ :,,i "ciioni bvinfl 
fnqwslly fuund, InJiinnialiaa of Iuhe tj.vMJL- m in., il/s<..L&cle«il» in 
pleuriliB uid bihiUEiaa oi Umg awvenuAL The areas invoivvd fiubbb 
tbc ugns of biuonho-pacuimirfA either ^jirpty loi~:tlls(-<l or Jitwmin- 1 
Med. but laiKv mclA m«T bm>mc involved wilh « com3T>3ndiag in- 1 
cnaMf In tJK frajikDrw or the pnlm'tnaTy tymptoma. By apcroddt of ' < a^i^v 
tbc broncbiil wjQ* through inllammalioa eidcd by the picauire of re- 
lafewd BKrri&m am) a destructive ulceniion, caviti^ arc formed, the 
pbjwalvpvoJ vhitb an fully diKVMcd on page tjo. Nirw CBVhie<i 
without a 6m liniitiag ntcrabrmnc may jiold douhtful Aif^nk* |«ftlcu- 
Urly If they ocnu In the (enter of a ca«ou« ana tadung broncfajaJ 
cofrnmunicmtiga. VanilnevaryiiieJae.sonidun(arcpmenCinjca]n3Ciatlhe 
whole rlf^ oe left chrA ai in the eaae mfniiofiM on ^^ i^ ^c«i^\ 





inrrcAL mAonovt, 









nviilo; BTv chllieriiHl by ■ p ra o i^ af ifasaqMion. fibrcais and ccmnt' 
Eioa; Urjce otviifea in«y be pftrtidly oMt]cr%T«] by the «afmc proccvo 
KTid bccotne inAfttvp. HrTnorrtit^ may orcur kI any *1B^ of a chtfonlt 
ulcmtivF lubcnriilcob uid tboii|^ ibc jijtctics arc uaoaltr i«^Mant. 
moy be ihc fini symptom. 'I'h« aroouni ta«i«s from i tDatv ttrvk i4 
hlnod to ihcmrr flooding tJmikUlsalaMBtmvbmlty. Biundiieclajwur 
common la advanced aar^ thv mtcsiiota ftre often LnroS^rd and lUi 
«mpiirjifii>ri, iLte likrraTion of the hryrii. {4 ^mbil, cihatiiilo]^ and 

^mfXOttii^— tarty ayn^timt. Thr mixlCTik tbcorrol th« curabOOf 
of tubomLoAU dcpmib upon c^Hy diagnuBls- Every pbysifdaii koo«» 
ihki coMV rtJcrrcH to hm b« bz«nt «r Eocifueat m hktiy to be Cu 
advanrrd, le. in the trconti 01 pi'^n ihlnl Kln|rc af tlic diirjHr, TtiCT 
ahould berecejca^Md bcfofvUic siti^cc nf cACTidve lofiknrtMa and cc^ 
b«for«Boruning>[ft« begun U the hcmrfsuluu* la biobiAltwd. Wbca 
to RcogniaciJ at tca*t 81^ cbd be rcalorod lo appaimt good htthk, 
and 1h« lorgvr cumbtr of tbeu ibouTd remain wU under pv^^pcf con- 
diiloH. Aiick fr^m lubcivk l^adUi jind cavhj lifnn □«> one siymptom h 
Dondunvc, but ihoae followinx *hnuJd be ootuidcrrd, (a). Lt*ss wf 
leHihi. Tilt ^tAtmi ^vfigMl, fkf htil uw4ghi, amd thr rri^kl fH^ to 
any ootkcjible impdnncnt ai bealtt sbotild b< aacerlacDC^. aa few oio 
devdop wilhoul fragrrstivt wtSgbl ?r»«.* (b)- /nrfiprtM*, Dy*p<pllc 
lymplonu uc t^ununon in ihr e^utj^ >iAi:e« «if lubcrtukvl*. ind loaioC 
weifi^t u of:«D aluibuted to tbjtt cjiutc when kl chould be traced 
badi, (c)^ CoMjfh- T'/^u mjy be tnUrdy obseitt and is frrqui 
unnoticed ft^d dcjueii by the palkni, evca tfwui^h Audibk Co thcccaiittn* 
Ing phyvician. It fs oftfin hanusin^ nn6 iTiMibleMme, particalajly in 
the adTinccd itage of the dbease. and may be emJrcty unproductive, 
budlf monr tbon a. clearing of the ihioat, of> attxialad with profvAc 
cEpedmatlcia or even baanoptyidi bra&f nftcntimca bronchfectaiic En 
advanced ntH {d}. Hfulttm. The »pu1aai may be abwnt. mucoid* 
rauGO-pUTuli^tcir|iiirulrni.4COofilinsiothfrsta^of th^diipasf^, Titb«T> 
dc b^ciUl are prcacnt in all a(i^-aj>ced oaca.bul a dlogDcob mual oJteo 
br mndt ia thdt ab>«nc«- Wfien fotiAd by proper Jtlammg rodbods the 
cWdcscc e positive and £riaL (e>, Pmm may 01 m:t)' nut be profuL 
and ia cftcs repttsentcd t>y a ffvliag T>f men oppmuon, aZ oilier 
limes t)eb|r ^ttitutly |Jeurftk: Jn ty|>e ot c}uU intl UI-dtfinMi. (f). 
^iwmto IA tic<iuenily prc«en( in the early iiagci of the dbease* and 

*ltobLul AfipmnriK li<<nvy ffriitMi mkj hnu Imi ihirtr or fofty pounds 
and inch patktoa oCloi receive acani i/iopiTtiy unl nrk propo eiounniaiwtt. 



fthm^ fn vhanoMi rMt*. In iht fdnmrltlsuMiietlineiof iBt dilor* 
ode tTpc. but ujudly one ^dthstf^nJatyuaai^ (see pp- :|Q7i 40a). 
(n). Djpii^a*«, Uytpmxd on exertion iA n»t uncomTncn tnrly ftud It 
sn tntatiabk iu^f ftymplam. (b). BnmthiHj, A dt^uber utracjnuit 
brc4»chitii c<- ctflcD spvmodic nsUimiL i« fomrtunOi pitMat vid may 
dmA Uw Unc Iraicn- In oilier instucA It b ft Joc^uof <Tfb^ »ff e^'vf 
hrvnckiUr. (t). ritMf^pfrUaHiai fricliim. The &uihnr hu ccmic 
10 Prpri with jpVftt fUApldon jritHnuil n^rmun. plrur^'prrkow^ial 
in iype •mi iittt Wf tfj wri fltef «M o dcM*'' uli-i^k l»/ ffrii-iriiiJit or 
fiftariiy. hui %^th impairmtrat of ihf ffttrraS ht^tsh. In Aevrrmt jnHtncf* 
QjQc tuvc puorcn iIjc Gnt dmiuiuitfnble symiflonu uf a n;nd]y des' 
tractive tuberculous pronn. (}). JViif Af (uvufj, Tim Croublcsome 
^in{Aix& if ordliUTitj UBodaicd wfl^ ttr Anjd Ma^r^ but may be 
dKMnBiCRid ■! AAy time tc llic foune '>f Uic dJK^uv. Sudi iFwcats 
AfV cUlitk^ And nhjilllliTlfE, il). Pttlst. fn tmn/iii/m ^-itfi akrr 
tymphmt ihc ntitAbiliLj arA unJuc rat^iliFy ^ tL>c pulhc u cMrcmcW 
cmporUiiV. (J), Timftfralun. In advanced ItibncuJosu. thp I«mpcr- 
aiure Is limjJy ihai of t srpllc frmcns, bcttig dtalncily fnttrmiiirnt or 
bc<tic ic lyric and mmotUi^ wllti nlRht fncAU, Wlicr new nrcfti 
ol tbehmgdsnir >rr Snva^W, ih^ irmjimrtrr k HkHy rn Iv mntEniiniiM, 
or onK ittnJiiccil. One a ctidly inlc^(etl^d in ttc vuinlioDA in in^pitnt 
(^a»ft uid hcrr one mu*t emphuiinr the importune* of any j>miaT«nt 
rise $}nm Ihc □omul. In ait tutmwJeiU «uc-j iitlA /ever, rttf in<m- 
iffBiH «« ir D/wJIy f« M# etv«>M^H fru' tiv may Ajty <in imverjc temper- 
I lA^r nM lAr atw^j^ kiwiiiii/- fioinr ravK hnvr nji ifrnprrAturp. nnd 
J one wider ihe autkof^a obacTtnb'on a few ycAn afo, Acnl tliruiijfh ihc 
I various M^ of the dlRMM to dMth vilhoui a rise ibov^ 99"" F * /n 
I Mony ««Ka a fem^cnaAirtf miftff t« ^«^ fiiUy after cxtrtiotu aa4 ibb U 
^ a d mUct flf the XKOlOEl inpoitAOfe in rcktion lo both diagnoia and 
^^^■tmoiL FunhoinorCi fii wjch cakk a wide railaiion liclwccn the 
pVBnliif aiid cTCAinK ccanpcraiunv thouf^ tte lailcr be wEthin nonoiit 
Unahi, may tir rat afrfou» an fnilirKiiitn rc ilu- Hhnnmud ifitr, (m), 
Fhtntcv^. The akilful uac of tkc fluoitocope tlunwa much lijdit 
gpon th« tondJIion of (Ti« lun^ m ind|MPnt tpxet and one ofl^n findi 
a mukcd llmiuiton ol lunf cnnvemcnt, aa mraaurcd bj ibe dcicfnt 
of the diaphragm, quile diiprof^nlo&atc to tbe amount of hing mvolvnd. 
AnaAof exlmtnr MlfiHtinn jdncrw ui»b»vdi)iN4. ^ml cavItJffiof omaJdcr- 

■ Tb« tue *!■* not nl^frvcrf in lU int-i^'H'iiry, Iml »4 nv Tf-mitfTiiliirD wat 
iikoira daring Ibf ctap of toTtpriliig «nr) nhm rh# vpTirum wji« AIW nrhh 
luterlr harA, ft te fo br pmnnvri rbAt ft wha alivnt ^ t^ eai\kT ttii^^^v 






incDrc4t. raAOMoosi, 


able txa u bright ipctt Linen's sign nuy he und to int cl 
phniptwk moveBwfiC m the sbocncc ot tbc flooraaoope- (n>- 
e$Jin. Thr uv M mhrrfiTlJn is a 4\lx^aimiic ss^nt has Hs s«traraBB 




snd lis falner <ippon«iiU; t1 Is srgunt That fnticriuch sc ihr <ymp 
ppoduccd SIC due to the pnxluctiun oT (onu^tjoii m lubcrculuua aicKa^ 
flvny doM tub}c£tt ilic p4U«nt fo tmn«<CMary rutki. On Ihv oihrr 



and cbr luftjr of bwl icsult* following hi on »tm M h> jumtfimkin. 
ftftd boch uc doaiblk« ri^t. 'I'bc «uLboir trc&rca thtt lif n«ttw 
Ku M III W t Mi Mi iiWMA On Ibr othrr hand niHn occuli>nftIl]r iriw 
whcrr the sEfht ruk iiiToln<l mvf be loLcn in the interest of cormt 
dufnosk. Use fad thil it k C4p«tJc of producitip ai nsp ol fftnper- 
jmirc ID ApfAimil^ kcftllhir conlrub Am) Lit Kftui^ <Ma of sjiihDB 
mftkei iU bndmj^ kM poniiTc thui mji^ht be wjiihel (o). Pamiiy 
ki4iapy. The UmHy lilticvy. u Uir>wlnK liKhi upon l&lcni inicainn. 
pwdiipcaitiott, 'jr the icsi>unc* of ihe ^Atk-ni. ihould b« cat^tljr 
Limtti^taJ u rtgmh halh indfSrntc uid ccuaf of aaa in brolhen 
and drtn*. fi*icoa aacI coUatcrsb^ 

paniitr fk^jitai mgm. a f^ nadUy fkppftfy^Ud if our. unuidcFj ilc 

llMptCtlOAL— Th* fkyriogmMy i/J wh^inifi lu^frcuityxis {g imt wetl 
kaoVB to Mod m dcKitptni^ tbr liily rtcognizing it aa rf*My n 1i» 
fiifjlkllili It h mmtj a arnipmilc of emarijLliiMi, heclic, evntfon 
^fWpnnUi, tJid often, od chcal cnn-fcmuAllon. Iiui^^tU cajex havt 
w* duthutivt fAymgrumj and mArkcd anamia ma? or may ooC be 
tnactiL "Vhc dicsi ttuj' ifctw conjffnjtal malf'^rniiilioi^ and aniiakrat 
wmthmg *i mt$Kk im IW rtipraH^ftdar n/c*^ ii of mm-h imfortaiui. 
The hnfMinneM of cbm movemfnl majr Im* impnre|itib1« in ihe incipient 
Mife, Ifcough reduceid expajukm may be »hown by tbr diaphntfrm ! 
pbenom^kaa or the fluofnaropr. Somr cnso pfrsrni a hi^^h ^olnr 
tkillir to thai Kited b the mElnl Oiyaae of jouiiK per^^n^ ami <]uc, 
appiMkl^i In iaterftfCDcc mih tfaa pnlntorury clrcLjlation. Atlvanccd 
ata almw aiarkod in^Minncnl of chcift cmiruDaiL. uiil u/loitioxa 
looliivd omCnctioa, aboonnal pvlMtioQ alccg the pu]inoinar7-<&idiBc 
bovnikrics^ and. ibe [haartnislEc phihfeboil i^e« 

Pftlpttioo.— Polpatke rnar be wboUr utfcaiiTc lc the indfjicnt stage, 
thm^ yielding Tooai eiqubirc hetu In the advnncrd rafa« vherv ii 
mrcab laptli of eJi|«tt£Jon< iacqualJcy of voice innam£»Eon, «Ijcn3 of 
cavilf or marked lAbimEkm (ac* ccauoUdokiion p, 14a and cavitlet 

P' wX 

PmvfisiOD.— In the- eftHieol siagni f«rcLution may be cegnli^Y or 
ftCtiMly rtiiikarltTi^ Anj inequality 10 Ehr ]irrc-us6f>n notea of the 
1VO ndca. pattkularly at ibe apex, should attraci attailLon. ti ihould 
be retticnibend diaL ■wwwiffy, the nole <m Ihe lef: aide U Iom mtenfte 
but mett RaoDtnt unI lover pitched tban Ifcat c>f tbe h^lit. H)per< 
nijfamn «l tbt «p*9i* if uaib(«ni. it a valuafaJr ti^ ot ui ic^^ikvx 









X Htj. 

M blUi^- 

prtfocn; In the hirr idjc li ia of o>un< l^k^lj co Ia(Uc«m Tic M ^o— 
cmphjXBU or xht jiraeracc of C9ritic&. r4lcbca of tJulocas hut 1" 
mad* out> or citfDSiTc vw of iD£llntioix. wtlh or vilhoul cvrity forv- 
ftlioQ. Acoirdias to the lUlua of Ibe cue. 
AntcidtitioD.— !%» is by f&r the moM fmporujni pfoccdnrv^ IW 

at rigmfioanl «J en intrt4K in Ihrtr iiUcnrily. Htiah bccaihinK wxi 

ib« lo-ctiled ciog-«bc«1 tnqjiniji%n nuji b« carifuUy Doi9d tfid tie 

litlcr tmat not be confoirndfil wEth ihf icAfunLlion uaodftted wiIIl n 

ovfr-itotiiig hctirl cucb & coaditioo bcinK frcqucctl}' tncl vilh in tabtf> 

' nilous Kubjcr[», Undue piobngvlicMi kA cijunibon, tbou^i li 

, pilchcd, rany be a kEg^ of Impottuice ind En tdwiced cue* with 

' InAlmilnn atid <itvlij fomiJiEifin ibr biTAiH tnuniii kit tnnk anri 

L diftnctcriotic (*oc pufC loi). /TAIm vi^y be abomt for a conBjdaibk 

prnod in Ibe Indpicnt »Ugp, Om oftm h«an onlj (inr ajbOftol twidi. 

moil vgnifksni if detected at iLc npcx even In tlif absence of otbct 

Hifiu* and pAnicaUriy «o if unilntcrai Evrry palictiT shr>uld be ttMide 

10 cou^b tn order lo brinf t>ul rftff*. *nd deep I luplnilon following 

cougb may b< attended hy wbilvit, enddbff or bubbling ri1f» or b? 

the Bo^slted mucous dtck, ancordtng to \ht stigr of tbf iturotf. bi 

■dvmjQCcd CMC? the rlla ue of aU lypca U dcacHbed on page 104. 

Comment. — CeittJa poinu an ibaolutdy MicrtijU to ibe pr<o]ict 
cxamlnalEon an*! art^ i}U{;no«Es of lut^Toilou« «i«n. A knowltiTfc 
of the ftoundtt |>n>du^ by tbo various inunceuvrtv in the normal thM 
is abnTufelj nrc^Harr. UnilnUmi t^Ofiaivms arr mfnifriy mivr mpcr- 
taas than bikierai vrttj m (hi irmpifni gt t^riy cata. lD&»mucb OJ 
!ho discuc usunJIj ccmmpnte* ai th* apei cr ipitei. thii n^gioll ia ifce 
mu»t ianpontnt for the diai0w«tkUn. (Butb ue affected alntMt 
CEffiietd«nt!y far more oll«n thac i« gaoorvUy auppodted,) 'Vht pttsoaiy 
1ra£on i« cumir<tntir sUghily jjoftTnfor to cbe (n>trT «nd Aboiii an indt 
or on incb and a half ^low tbr iip«x- The diAfUo tends I0 fxtrtid 
both upward ind dci^nwnril [i]r>ng the jnifriobar lunire and in front 
oloni- the bncr marj^n of the u|jper lobev PMUfitf apical amscmUoHcm 
lA uAunthr more pTCMJuciiiv ihjin &nlchor in the early fttftgtt of the itknse, 
7^^ irapt/rl'tni tirtat trr the api^. artkrhriy imd p<nltri^ty. M# imut 
lung hfltdcrs a Htfrtarty. t h« QpiJt of On 4jnUary tp'3f4, and, ili4 f^gimt *} 
iJu tnterhJiar ^nvre fknutv^y u roughly indicaird by tbe Kapulav 
bolder when ihc onvL b placed upon the opposite aboidder, Tbe lunp 
may oftpn be more imnlved thEin phyEicjil d^i woudd bdictie. ai any 
one nay prvw bv ibc tue of tbt X'-Ray and thU fact no doubt acoount* 

niumttAAT Attfcftw. 


for tfw CfCDt* ii po^MBi *nd failure in UMtmml in cauvA jiidgcd win 
b^ the phyiicd liKik*- 

Apev MoTcmcni. ll b impc^jmi co mipio^ aUKullatnry per 
Ciwuifin ovcf the aplrr* fi> ordrr Ut iltirrmfn^ ihr hrJ^ht ai which 
ibfT Kand aad the difiocncc iri Icicl id bctvrt-cn irv^inration and 
ufinikin. MarkH iMrsLCtkm of on# spri is kn im]KirtaiU Kign of 
ehbci ttQ 0I1I l««oa.or ah active mid attvivndng onc^ Tbe di&|dkn^pn 
pher-'mcn^^n has ilretdy beoi ducnbvd «,p. ^), 

PULHOIVARY IITFARCT (iJubLonAi^' nfxiplciy, hcmorrbasic In- 
farct* pulaocftv^cmbohim),^ — Aii^utMiintkeptJmimaryiift^fingitta^ 
£tt lAf ri^ Aaoti <ir ir thmmbotir fiyufmir vrfni, uml may hr irptlr or 
DOoaqAk- The foniKr occvf in p]rrmi&. Ltlc«raiivc cndcKBniitif, acpti' 
Ottnii anil ex<ir|>1Jnna1I)r trwtt kci)[« ft1>ril«(nfci:tir>nfe;thFlart«rTt!liilt 
tma the iIclttdu:ncaE of tcgcuiuKu fn^m the uku9|ii[l ot pulmoouy 
Mhvft or b«ca a nenote non-septic thmmbu^, 'Hie rentlt I* umuUy 
tbe bkxklng of ■ brandi of the iiulxnanjiry atltiy whkh mum 4 local- 
btd pnvn&Qttb pritmriLy nprt«entift|! tb« dJitHhut]'>[i of ihft 4fl*clcd 
iMtfl and in fome £n*lucv» leading to absents or gnngmip- Tfat 
ana b avuallr wedge ahaped mih iti but at the iKnpherf. 

SpttfitOtat,^IiHy infarcii niov 6f trhcUy $jmplemitss or frtnitti* 
otdj lUgkt UMJik, JytpmjM^ and fiet)mpi kamvptyxu. IJ br^irKha v] 
niMfrrdfr m« k vnvhW tb^w rymfiom* tre mtfrt prtmintniftf <tr Mfrd 
ta^nruamd if atargfaherybfugtcMhislintdtiiSkmvIfs. Thr »utlr1en 
oasel of Auch sjrmptotnf accompftiuod by ihc phv^cil s^yia df fireHHj- 
WVAtftf ^WMV««M «f ^umt'^fMfMTfjHHit. (KiUffj/y Mffj/, in the prr«(*nce 
o| trvofniatJ <aiUAti vc facion makes the dlagnous casv. // tkt <mbolu9 
W uphc tkr eau to^iaa em 0/ ftttrnmofy abnett cf gnH^rmt. II Ihc 
KfHic denKiU be alacoi fiiofinoata ia fawfablc ba refianb tlu luiig 
coadhkiaH In sepHc ca««a il ii bad Multiple inlattu may oecui and 
Ibdr bcfllioe be euily ilcirrmiwd a> iri 1 (&&« remilly obwrvM; and 
tbe pjctufc pAacfited. ttf, jwUm htaiiifJ fii^ dyspnoA aitd hhody 
ipuUtm ti cbmctcfittk ri^en tbough die phydod «Ign> be obseun. 

PULUOnART ABSCESS —The obxeva nay ^ imfAr rv nWli- 
^ (M^dbr l»JD£<pm/df/i- JtpMtamii*. pytmta, ufhc fmb<ili, foftor ^mf 
h nmc kt I ^i wM Wtiai g ^ tnoJirmnf «mJiirariiliu stftd iadrtd If iiipptir^ 
duame n/ ofvy ^^^m ' vlntdivv adj^fni or rtmcic. There b 
ly an uaodated anpjnema with embolic infartiion abamnr!* 
an: often rnultipfe^ Oihtr ahace^ses may be dialindly locallud 
priDiarily bi3i ttT^d ta mend, 

Syniptuiuis.— TJtf lym/fiynu up« ihma of ttfm Okc K^^iuckvNa wcv% 











Ldvtr JMe 

CMv Attt 

or timulate jui encysted cmpy«tiu if n^icrficid. tmkM pcrittr 
ftikm orrun {mi«a Lomauifklj into k birmcfaui) ukI e» anodMol 
wilh tbc «u<idcn Apiicanocc of & ourcii<lci^>le iputii; oi 
tjiiilum which tbrn per^«« vtih rihtJnn carti^r tigra; The 
b foult CDDtaiAS iWic (ianic uid oflni nl fint or 4t aitenob rkr 
or l«si blood, ii vill bf luAtA that th« lymptomt of Kpiii Apfilj la 
jUI fonm; bu< no»>pcrfof%tkig abscoa may yidd 00 ovnptODU or Mil; 
fiercuMioa dol&afi mud, comprttBon. 

Progooate,— Roibn&c abcccM b ■fanoA invaHablf bul ind ilw pfog' 
notts U bad th «11 Ihouftb tbfir court* iiur bo pioLoci^ or nc v rt r j 

I PULMONARY CATfCREIfB.— TAf dM>of h^tanmMt/lyAm 

I 0/ ptJmtmufy ahtctss. Is is j fart ttrnpiit^i^m i^j diaMt» 49d 

I aupHotutily flirt in lubatuiasii nnJ vniia rtt^Iv ia rxtcoL 

citlicr drainacri^Kd or diffUM «ni1 unuiily bu< noi A^vay* aftectinc 

I Ihe tovrrr lobr. T/^f imufwif offias ur« ntnvwMtod Ij 

! c^nce^lM iff ff^mwf^Kj iwu. An auotMted cm/jwffM u 

' pUitrity iwi'iinablr m the pm^ktrol kams. It ibowa the mwam hmiti^^ 

lo |)crfw»[< »» Oi>c3 obfccM, moM oonmeoJy into a bRmdniA mw 

' r&rvlv into itw p1«iiit or ncn tiiv p«rlc*rdji;tn, ooaphagu^ or. thraujcb 

ihr dinpliragm 

Symptoms.- - Th4 enly $ymphm agff&iMini Mc Jimm^ ^vn pi- 
tmmofy ataifn is tJi4 pradiaHy lurrihk odtv of Ikf tfutum. <huKUf- 
btkftlljr E&hKrriii>ii* And nniulatcd bf no rnha conditkm ocqit pii- 
moiuiy cvrinO[Ti4 viiA gcm/^rm*. Owing io oomt pvculUr fermca 
lAlivc Adtun ibc [^nituni tonuintt no cIabIh: tiibue. 

ProgDOBtB. — EmtK>hc mali^Ant uid dinbetic cosc^iavnnAbly dk; 
\n oihcn ihf [HTrijnicau b unUvurabk biit nnl Ahv>lutdy hop^bat. 

PULMONARY TUH0R6.-Uf>)y tbc nuUjpkAni i-Ancty neoJ be 
cofutdeRd. Prtnurp- «rronia it n ctinicAl mrloaity «nd cAKifloma rut, 
both bdnjE usually nitU»iAti<, The icurt comioon pnmuy focus b of 
coon* th* mAnsfnArj ^Und, leac oflcn umibc, gaoirLc, rticUl ASd case- 
oils i^wtha. PuliuiMiajy urn'nonu b mcBt oimniao In mUdlr ».ge. 

Symptome.— Tlte djaeotc is cfUn MrikingLytymptoBlm forbo^; 
ppTJnrb or bafRfng uid IndpicrrTLlnair. ihr vfv aitd localton of ibe 
fiowlh bcifix (he difd fAdoi; ubAtitiAtc and viiilcnl cough majr <ir amy 
not b* j^rcVTil SpuTiiRi fniy b« miirdy abBOit or Liki- prune juke or 
L^jriAJil jclly» lil<iud btmicil or rrca purubnt Apd of ipn^renouA oilor. 
jAod coalAiriA compouod gruub celb. bnolTcitKnt of Ihcpbumnay- 

ftiM**M Of mE BITDMIICAL <UjU4ia. 




rv pftis inrl th« ilTfpncM (j>u^1y pi«wni ia »inG 
nuy be ^Inkin^ pUDAjnul^ prramir ayinptoms ma}- be muLcd 
and ore often Jdcalicai with tboK of aneurism Cvc paj^ 9^5). Fever 
U fllim Dofied u die dboue acfvinir^. prrdiu tif mnrhiijEr omuifonAllv 
noccn tD^ then may be maikcd liuplKcnmil of tlic hcvt SocondArj' 
gTDwiht V tvuall}' uiggrviiyl by h prirnAiy lirstnn. hitt pr'mary Ofifs irp 
[rtqucnUy bfyonJ > povlhr diagnctuL Tlic X-Rdy may pivrvc laluiblc 
in mdi c«ac» and U the gnrvth be OiCceKiblf xnd of corutd^mble «U« il 
may yidd pcfcuwoo duboB. UBtully vithi^ut tubukr brrathing. aiid 
iiifTruefi fmdtui. wen rwly, iJ attftcbcd I0 n Utrc brcoichu*. both 

PrOfEDOSl*.— Death fAvarubly mnilU though only aftti a period of 
«n«n] monihs.* 

poftant oi ihc«e ^aacta be in the angle oi ih« tmchnl bifurca- 
tkm about ihc iitaia bnxidu. Tbc smaller flnixdn follaw Ihc counr 
of the bfoDCbi L>iaj[ in Ihc Jnicrbbular connective ti«ue. 'Hey 
muif <hfr?rty be ovwrifPfil in rnnncrtifip *rirh (he *fImeott of 
dnldRS 01 adiillA, is pooaibte aouruea of xtondaiy cnUrgerocnt with 
or wftboim lymplOTni^ It ihould also be remrmbcfcd that gannrcne 
of (be luRf may lavolrc them and lliat thraugh <Iiuty occupation, (in- 
halation ol duat) they may become pLgmented u>d vimcwhat enlaT^bd, 
The foUowLnjt iltitaMa may alTca ihem:— (a)- Severe ai.ut( bronchilb 
(b>^ Searict Uvrr, cneaaic» whoeplng cov^, (yphcM'd and eimilar 
ailfnvitB. (ck. Broticbnand hhar pneumnnl* (rf) Pulmonary gaa- 
fraoe^ (<). Mediastinal, or. by mdaatAau. rtmot^, aialiifnanl growth*, 
(f). HodgMn'* diKMr and leukn-mia (c«pcdally (he lympluitic iorm). 
(g). PidnoDkiy tabereokais. ih). TubcftuLjuA ni nmlji^nttni dc^caK 
of Ikr M^miftat m tt^-fmUateal tlruclurc*. i'tic jip^jilcr number ol 
eaora in cihndreo >jr due t^ tubrn:lllu^]K ihr prmiary ttmtfv^ of iitfrctfon 
being «ither gascro-ialMtinaL tonaiUar or brcDchiaL. 

Synptomt.^ManT enlai^ivrnts arv iym|itomlf-jB. in oiher caiea 
ibt c&cta an thoac of preuurr withia the moduatinum combined 
vilfa phyriol tigu chieAy ob«rvablE m the inicneapulaT region and 






* In Ihc oul^ <a*e of pdinvj Mjcoma of llie lunu oUcivel b/ iW Muthor 
00 pgailjire diacaona <ould be auuW durinjt life. llv>ua^ thr allmeni wu 
by teaMQ af the preulk/ shulcim iluva hy ibc XRiy^ The 
««n iadetcrnuaau, the heiit ti«u uid pm«arM cympt^itni 
bal naavtaat auaMirt of anruTwr ind the auiopay ibcvtH until 
l^o^lhi, oOaierel tn dlicrttiuiion (haugh (hfeBy atleciing U» 



WCDIi:;^!, DUG1«C«I*. 




upper atenum. Thtm ll^ m ttiuaUy to indcfoiu^ Pcc um ng 

tlif]r do Iq utas miMl uufavonUr for prniininn or ftUKcullatioo. iImz 

ibcGvl^ dkf^oakfV9Ua>uaIh'iipoQpc«9mrt spiiptomaaAi] tbcknowl 

tAf/t ol RA adC4^te cnuae. <Tae cQbi«<i of prnauirv cymptomi ii 

I Lborou|(U> diacuuod ufulcr die btJifl ol uicunxn. f^^iee >05.) The? 

Vv fffiKtlc^ny lilmtlol In ill Irjimi of mcdiuttna! gn>wth« Ihov^ IW 

moot distrt^ring taun. ott ofjMrmI tijr tbt lulbor tavT brm Asncvlfl] 

iritb the fclafkdul&T cnUrctmcnt of Hodi^m'A dbmse. 

I HEDIASTHTAL ABSCESS.— TTiit ntr^rtiy mre ooiutdoo on 

I be aculc M chioiuc. and occun duefly in ibe nuk in cofta«<lloo will 

: tnattMteii. the tcute Infectious <li«efl«ei. pulvwnuy ibucett. pnpt>< 

iJT advincfil tbbdoikttb. It Is neonoLKil br tb ijfmplomB of <iyvi 

AasociattO with Mrtn tutMttAd p«In ud muttd prtcmm sympCvvK 

I ft nwy nipluic tad prmlace k fluuiutint; tumur in vi luiennUjU i^iarr 

l<tf dacJMigemtothccaophftpiPOfUachqu The unofftjIn^mipiiMioi 

I wadlf urmlD J nuka the dlftgnoaU 

CHROinC UrTBBSTITUL VWEUMCmA (fibred plithfak 
liulmoniry drrbotlt).— In ^pltc of ywt of obMrfitkn th* cooditiiMi 
fhtnarmrd hj rjUm^e Dbnnd duni^ nmiAin impcr?(xtlir d4sd6Di 
In 4 broad ocn±e jl b h««t livaled ucder lh« cac hemJbf; ftftd we nMjr 
Mwime ib4l loh&r pncucnftnbt. hfiuichD^pnmintcmk* old pkwrtilii 
ajrpbilis> tcUftococcu* cp^s utA tubcrculosit maf operate 1o pmiun 
ft letioiii tbt chief dinmeicriulf nf vhicfc t« ftbrmlL CftvM^^ difuf 
ii«faEr«fifibJ /vKAMHua t» cxcnBivdy nm tt & KqtL<!nc«' of ftcuic kubAi 
paeumonU though i r«w cum hAve bven dctin^lwd with vomv accuncy 
Chtmit bnmcHtfpnatmama la rnocr conufMin hui a umiolly nibffcu- 
lov& jin inttrtAiHat pncumfma f^nowin^ pleurisy (fileuroietnavM^ 
unionhEedly cifcim ak n mult at fimlon^ fofiiprrwlikfi. \t being amiv 
dJLtc<l utuftJJr vith n K'CAily thickened >.tid vlhettitl pIcuA. Tbc 
ca«tt of inwmll;*! pn«uinani» cJtie to ooniisuoiu Avsiy otxupktkm 
({jnccaiofliokonioHB) and tbc 0)fJuliiIc tubocvlous vid edimococcu 
iarmt irc bcKcr undvntwKl. 

Morbid Anvtomy.— The pmcm may be InTiw (mMxfve) or Inbii' 
Itf (pcribrondual. broncho-ppeumonic Iniabif)- The tound Tung it 
tavkfdty errphy^armAioxix 8nd the hmn U ilii^ pushed and tlnwn 
towda tlic diirurti lun^* fnJoioDAry 4hrinka|!;e and 4dhraicffi> bciDf 
ufUAlly nurlc^l lEiovigh wmttimc bdcing (e-g- in FncYipiofiokonioKU). 
11^ Imig ikBcIf may be miurebiuTy tbrunkco and »liow chnmic hn>T>- 
chitU. multiple bronchiettiiM und perhapf^ anenrisjr^ dilatnticcA of 
the pulmonuy Atlcfy, llic heju*! Is «nUrf^1, lu H^hi chnmben being 



BfRdilljr ifilalcd. The vajM oaLurr of Uie lesam tnakra jxauble, 
wide iiflF«ft«cc< in prst txi6ftcai lindinf^ The mtut utrvmc cdk*: 
fepi ami Ihr mcivdrr fnr:n of ihr dlnrrtv, whLtp fcumtrnu. Jipicfti 
tttbcmlou* cavities or <ch(iiococcia ci-»t« mt)' indicAlc ifac >pc<i£c 
primuy c»iM« M tniy tlw ptoili^ir pigmrnuiJiw ai thf cbnur 
oboerm) in cues of aciltmcoM (<ot\ mineral diac^uc^ and udcrous 
4dve to QNUilJc putkk*). duklicoau (griDiIer's rol. ttone cutlvr'f 

Symptoois.— Tbc •japionw Accvnldj follow the morbid sAilom^ 
JM fUie<L Srff)^ ihmw of Ainr>}i>«rmM- dtmi^if: InvmrhlilA. limnrhifviiub 
oiT chicnlc phthi«b> accovidvift U> llic lutuit mi] extent of the TeaioWi 
tonUwd v[lh phyticat fignf bearing the Mine reltiion lo causatte. 
T%t tIbpbccmeDt of the heart ntnctkm aqcI immobility of the affected 
nde, «co4iiKii; »iid ibc deproaed shoulder oiv cmphatiied by com- 
paifaon nrlih the TolumJiiou* ttppothc ddr. SjmpEioiM cd marked 
JwjHfraifjw arc viuaUf (otmii (jul vAn wEdely vrilh the dcj^rte of Envolv^ 
mcnt- TtiC dtv^aar H ncjl ^jnly mr:iilL4li1y r-lirriTui^ liitl onr whlrh 
penuta onukdenbk actiTiiy for ta&ny jth^a or cten far a renvcably 
lo<if liteUmc * 

PULMONARY SYPniLJS.— There are no chanderftlic »)iD|>- 
looia ol tbii dlMaae ithicia moct coDamonlr BuAifntft (teelf aa iai«t- 
atxdal pikeiiiDooia. li ocmn both in ron^niial atul te/tiary a^iiulR-il 
syphitb- The so-^allH uhiit pncunonia i» cf do cUaLCol importance, 
bdBg fiiund onlj in ihe longi of ntf^d babea uiually uiUbarn. The 
former peccesa b frcquenilr awodatcd wiili mbcrtuloouk In acquired 
a^pliili^ fummaca. artfft or multiple, varyios in siic from a antdi aerd 
to a bcs'i aye amy tc coixiunu^etf. Tlic (i1i>tiial sitEMS are in mi wa^ 
pacuUv to syphitifL Wbclha Ihnv i» an ^ttiial dmiruuivv di»' 
tmat or the lung and Inir iy])hiliiir phlhiiJA h aiB drbaiable. Tliere 
an certainly rare cues in vrhid) aoftcrinfc >* aawdaled with caaeoua 
gmmmata and dadlu cam not fiUrequefitJy occur in connecikin with 

* Ofte one (ilcrrrcc) bf the authur dLtniw « ixriul uf oraftf ao jrarmlma 
paved thraach >nera) H«en EUncHo oad koi tirrd to ace hU tw-? hH^tlir 
wndtoi 4k e^ acMe dkcMci aaoUicr <aM, jlkowiog Ihr duttlcal tigiti of 
~ IjiMm aad envy ^vkdtncr «! munTf chivntc fibro«i«, hwi undcf- 
■n ■(^vfidkKtony acid Hi^phrtiTomy and ttvcroJ aliackt ol infliiuxL 
wttft bat* bm atnaoat iviniiiiuoittly ki work rluring ihr M-holt* 

t If o one can ha*r fiilod to oicouqut aatt of undfrubrrd antutroil *y tililLlM 
hi wtdcb a jnbSAf adraachs tabcnxdout pfocoa nbwtd a miiktd Irar 
pei^naatnt IoUohIi^ ibe uie of tpecMc medkaijori. 








FULHOKARY ACTUVOMVCOSlS.-ln all fsmtia] pntkuba 
ibuL iHsHW pmsmii th^ pnciure rd pulmnnaiy ttibfroUoai usd h> 
diAjpiiTM AlmcMl invAriahlv dcpcddi upcro the ncc\cry ut tbc ^edk 
iM^ntam from tli« spuiuin. Il should be Euipcvted II m mdt cun 
rubcidc bsiilLi arr aLtnil. tLc b&wa cliicll^ <jr prufiirily involircd Vki 

A3PER0ILLOKnrC08l&— Tlni nuv ditvur ts tlur to ihr vcpo- 
pUut fumigAtus uhI bu been obiaved chiefly in IhMr w1m> Kftadb 
Infrdfd Sour. me*l or gnin. The <)nnpionu vk cjBMOtJaHy thowo' 
pubnouxj tubciculo4l« i<tthutii ihc badlli and ihc (fiftxnoeb <ab be 
ni4d« only by tb« dbcovcry of ibc mj^cUum, li may aUo occur u > 
Ncondvy dinm la cDOnrciJDij wiib Uic tiiriuu» cbrauk polmiHuiy 
ftilnKnte MbA waif ottuzne a. pn^IomiiiAtin^y brondiioL DoduUr, or, 
riVrmoui foniT. 

PULM05AR7 HYDATIDS. -Diaffiioiii.-$o bnn u bydfttai 
cyiis fc^rr crntml and ur^ill. f«w i^r no Kympionu nra ppc>dure4. 11 ibfy 
enUntc. and pautiitikrly Lf t)iry lUKii the (rktira. cuujch ukI pais any 
be severe, Fcrei is uauaJiy obaeai. ucd dyipna-a di^t Phrtkl) 
signx may be bAflline- IndMnnlulc or, ihfor <4 mnwIiiliirfAri cv 
plcttritk dluflk)& iriib Ibe Cfual pvcMurc <tl#pla(«ncnu but vcoioicd 
bmib tounds uirfdlnJnbhnl frv^mltiiA, Thrtmtof rfu1nnsBiayb« 
clunwtaiatitalljr drcvUr or wilb j>Vf>J ti'f tHusien ibrre mny bv ouuM 
fttwnt jrUH-^n o\-*t ^le ■!«■ of dulnnn u io Dr. Itriilowt'^ out.* U 
t^|)lu[c occura ibc iiumeduilc tymfitami nuy Ijc uigcnt. tbe trttny 
nature «f the fluid u i;ujQEoEivc hnd ehanictcrUtlc and booklets ftiid 
fngmmU tif thr mi^mhnirtc mny Iw prrvri. KfrlatJd ihrill tnd 
UpCifidDl rounded Ciimon ctty be fi>utid. Fowkr cmphawics the rd^ 
atin$ ablPncr o1 nifiJMjfnw/ fffiittrt sympfomi fip« uieuTiim) despite 
tbe evidence* of a t^rf* trntnor or trwhk^ 

I CHYLOUS PLEURISY. -A chylolhonu rodu uiuaIIv fr>m oc- 

. cliiftfrin or ruplitre 1/ ibr ihorL^ic dun or rerrpiAcuhtiii (tt)lL iiM.iilly 

A» M rctuU ai nioLi^ant ur lubcmJoua diMair. Tbo diai^osia am 

nnly V tnHdf by the cUartJvrry of ft plmnl efTiitlnn tadthr mnuvnlof 

A portion for cJtiminatJon. StttJt casa htA tmy HOorj of ooM 

under the bond oJ nuUgrunl j^rowtbi of the lunje Applies bee* nn lb«t 
ihe pn'mtry dgniandsyttipioDuue fktinil. N^M only b pleunJ effu* 
sion aunulutcd but in many iut«soc< actually preoent- Cardiac du- 

*KclerTV<l ln> by Kowler 





;tK h tamDy Iqa inttk<d t£iKn in tunplc elTusiona but u»ittUx 
ft diflmntftl diagnoiii <SqMi<l> upon thf triibElnw&l «f bloetd lUtoftd 
iuid in unonDl clupnipartkiiuiic to. or wilhoui a pm^r dlmifiutlon oU 


THE ARTERIAL PULSE.— Wb-m-^i-r [v>(.> thv pitr»««hoL]K1 
be t*icn avioli^ vhilr laLkJng of cilLrr nialtri? aiJtl aikmanii: m&Jc 
loc tbe ncTTOUKQei* incident Eo anmautum and the tStCL ol pihysiCAl 

Tecknlqtie. A correct !c<biilqQC b of the dUvkmI Empoftuice &nd 
the i^tlmrt arrat ihoidil ht HtmElMty pUfnl In a jviaft^ fn^* Troni n~ 
siivfau flcarioo, or ciuscuUr comprcasion of llic vtascb. The pulse 
tboi^ be ttk«n tiicuhuicoailjr in the two la^liclc Bad ihitv lin^t-n if)- 
pUcd Ij^ly oTct the artctv at ihc wmt> 

Potots to bt Detcnnined, - (i), Th^ riu ^ the atttty. (a). Pulse 

riUr t* /rtqwuiy. (j) Rr-j^tdntUy <if fkylttm. (4), f'trtjamtky 0/ 
t^ttigtk^ i%). Sjti^ nmi jm and tqit^iiiy v/ ike rif^hl and U^i ntdmX 
P^Oms. (6X TAe forte rrfwiraf r*} cmsinte tktm (tuuioD,) ij). Alh 
men rnt X tlHekemt^t vf ike arkwjt (jtrtcrio^derMis). 

What xbt pbvodui's ingen arc appJi^ lo tbe utery itt fint Coot 
polmi SIC dctcRiUncd tlqaosi unciinKJomiy tad JitHUnuncoTuIr, tlic 
T«ld bdi^ Ugl^ rolM iindcr iho &a^ lo f^ aa aoc. and pnavurt 
nailc with the ttpper fin^r imtfl the pulw Is Irai ti> the luvm, tbe force 
cicTfcd bciDg the mcftnuie oi kntiom^ Tbe empty aHery is then roUcfl 
vndtr the lover fij^fiw lo <Wwi any thickening of it* wjUa (tfrtrw- 
itffffOjfl) and any vrurl ihiti etiti Shit Iv JtJt m a diitinrt taht u xUt' 
etic aai Aoictf oluwraul. S^ch may bt tncn^y pilpablo; dUtinclty ^K^^> 
or. cvT> liny fJaqun of Utnc tal», 

PncABtioBS.— It i> otdkarily ttofEdtni to count ibi^ pulse for 15 
Mttmils Nnd nmltqily by 4 la get the ntr fcr minLite. hat ff nny nbnor 
nftflks in Aylhm. quality or fonx be pmvnt* il aliotiMbe liken for at 
Inul one siiautc uid if c3ccanely mpKl ti may be ni-'ceuAiy to count 
eTco wcood or third b&ii. Ni/ infrojurot)) , oinxi^y in certain 
TVhiUif InlOM. ion* «ys1olM ar« intJtd«ntp a^d. though nftdtly aiucuJ- 
eattd, yktd no putw wivr ukI Eti ludi eaM» nurieH* pulte rvconU mtt 
Cnqucnily worthloM. A recurrenl puhe Ja on* ibni cnnnot be col o3 by 
the pmnuif ol the upprr finger beouite eti vt unimiAlly free commuri' 

*Tlicrc b bo better |jruil *3i biil tialniol thiui the Jtii^crly uae-(in|E,erT:d 
apyroaqi aisetinkea ovMrvied. 



?^[rtClll nil 


FvBtlHHl 4ir 

I*ii1k imi- 

Ifmtbn aod tminrtti flow fntm ihe potourftrcfa. Thb auj be olrnurri 
by nukinf^^iuntiajE pnmoK vilfc the bircr fisc^ •ndc^tTTncoi; 
the itful pTDO^viT «boT«. or. bf <oaapnHing cb« ntaur anny. Fi 
IxjsiiiLJU uf tkjt iniLrnt'i inii uii huiJ any ^rciit^ inudiT^ uiy 
The brotrtn thuM be slightl; Gcxcd apoo chc elbow, tbe vrial 
■Ughllf bNckiwrdp Mid my vHghlly iupituiicil A dtrk^vi staAou 
fnqoaitlir f«ib lo dote WflqiiiJ Jietfn in «KOMd]n£ b««tt or junfi *i 
condiukina U b« flfiili x utijUKnl mskvntes flv ftUmot of ib« pyiM. 
The fr^nncT b nual tmpDitvil crklciicc uf driitknt bcut Mmfl^ 
t^e latUf is on&nuilj du« to Aa ibngnnAl cvunie of ibe cidkJ utay. 
Off mcnc nudy. to actual bbcking cf Ihc vcsd or to aacuriafi, snd Ik 
fiD<Iiii|ts must atwA>4 ht checked by rampftrinK the lArpt ulerica. fuch 
■N the hnehlflb nf ihe cwo iiric«. A jtUl bounding pulv- b Inqufody 
mittaken f<>r a J^rJb in/*^ pubc bccaux of f^uky lecfaniquc The 
orrrct rlcirnniaaiioQ nquirci fnudi pnclicc ai^d for cx»nw ftonmi^ 
cicnijinds the uc of the spedftl itaUumentA. 

Pulft* Fr«qu«acy.— Aiide trara meatd cfdierMct, the iUgptlfn 
pnxxu nut} kK>Uly exetiion. which UjI«' ini ludest evm iberflghi dbraih- 
■A<« due to KAiljuMfaml of the poAition Is bod orewuftlion of iht Uad- 
der or bow^l^ ih« fc^ftbn of il# body tSlHtt the finding vid in ercci 
poBturc the nte is from to-is be^td futcrlhaa «rbcc recnibbcnL lie 
■rnmg p<«ture ibowt a nt« sridnrny beCttteo the mo,* The Arttajt* 
normaJ nLcai ut far tlic Am yc»r nf ILfr fmm j^-140; Frnm the fint 10 
the foujth you* gntiwUljr droppinft 1^ to$ or iioj vid m dbnuibbinc 
UDtll ft[ ihe nitctnih or sixinaib >car il rr^cha from 75 to Sci bncs 
per maulCb During middle age uid up 10 60 yous frc^utL<y b iJightly 
diminUlied. KonetimM increvsn^ Kmewhftt beyond Uhal »ffc- Womai 
ihtrw a rak from 5-^ bcali a minute faiiet than mtn, »jid it h tUithdy 
sLcwer ia iilt than in ihort penonL /^flvr. Any .ihm^nnaJ incrroM 
b fnt^cncy su^^m* the uk of tlie dfalc^ t1>nnioiTictc-r uid wr find 
|tbAl t»% nk iiu ralf intrsOMt Jwm S-10 hMh per mimdt f^ «0th^egrM 
of iemp^iitvrf abirM /Ar RtvnMf. and further, thai tlw brhavfar of pufse 
in lever is of both dingutialic and progncttic impniUnccf la gcneftl 
nnincnnaeintlieEMeoutolfomspoodenccwith :hc rule i^^-en luggaoa 
dbolobbcd iCftisUoce lo the diw&ae uad LKJii^iiuin il daiij^f aipiaL 
la thoM few dtfOkscu in which (he pubt nt« ahould be birnr than the 

•Thia viirbeien vrai fomcrly l»lisrod b» b* due to pub« tcn>Mn «« 
afffnrd \^ poehiir^ a ibeory eiiploded by Iht Uci that ih« iphygoiogntpb 
Khovi but a friflbft varUlinp in prr«iut& 



^md r^t^%Hy jf^MF ftUtttvc ohurved eipttMUy m tt^rcntd^tr ftmiiiiilu, 
fyfikvid /nvT, y^rflfi^v /^tvr jnii fflfrfir ptt4tafU>nui. » wt^ll un in f^-hrirt' 
ullttcotft AModAied wkh I4me ffj At trgani^ oimcs of shw tKurt, jwii 
dx tofp^e^ seUtMt, myoeafdiiu aid a^rtk tknasis- In /AVfiiA 
rijMrni « niaihJy ft^ t'tU h f*f }iit Itn siifti/ifiinit fJtdn in th< <id\di- 
A f*pid ptdn cifturi m many ntn frimit u^tneniu mt^*! marloilly in 
nophllulinrt ^niiv ancl in ihrHJighi or marlcM ircoiTi[irriMiiiiTi thi^or* 
or nttlnl Mcnoojs «Ad iruuffidcncyH myocArdilis tLnd ju^rtLc mmil^dcficy, 
•nd In «cuC8 eadocmrdtif^ pcric^rditk «iMi. the pm^iiiv {lLipl&c«mentft 
of Qk bevt. In fhildnn an cjwujiiiriy fd^ ^^c muv i¥igejl 
tht fimtti #/ KorJefud bcldrp Ifac ippcmacc nl Ifac ra>h otkI rn inci^oif 
p ^mfim v j itabrntdimt. am fodittiiU onJ pcHilmtly tiver-r*tfid ^-tt 
M M«tf/ IW miiif t*nsku4 emd ti^ifcatsi ^f th* tarty iif^. Aaj<k fiom 
llmr oi^DiK distLirliancr^ mufl b? ciinsiclerpf] fuuil nttirasULcnia, 
tbc orenise ol tobacco (often Ajsodatod with polpilatkD)i pbpjcoJ 
tod menial ovmmin uid i^atfoataj* 

TitchycaixUa. Mm: tiiraiivt mt^dfly. punxiyvudl o; [crhuLcnL b 
known ia Uchycarlio, ind thii Krm should be airi^^lly limiUd lo tJie 
pub« ffce from invEulnrlljr. ImmnuLenty or kUncifoml ULTenlusiiuii 
of the h/etx wunrU, Aa cjiccvj^cly rapid '^rvnmmf'^" puUc anocEAlcd 
ttAh QUUlicd PTidtncT oS ru-rllAf «<»kQ«tt aftrl ™ftpc*[|ve hick of 
iCRiiTujiiiin b « fi>rtniniitf of de^lh io ccfUin dlMma^ 

Bn47ClvdU (brachyc^idb).— A vtry tXnvs pul8« m«y b« pbynfo- 
Loflk: bm axtfl of ihntK IhiA docnbcd havt suUtfcjimdy htai provnt 
Io b> <lae M cj^imc diicace o! Uw heut or bnin. ExocwWely low 
coont (30 bcAli fo ibe miniitt) nay be [uandatcd with cuniEury K'IciuMa. 
faliy m&kfatlon uid injuries^ Lctscr dciEncA ol slowmfc may be mcl 
vMh b Kirllc itcticidt, chfonEc myocmrdEili, (vrrbral hcmorrfuific or 
lunor* BxiMAjptk, cpQcpeji gciicrai paraljftuof tlic inaAnCp i^irIaiii:l^oU«H 
nonb. mftmdmn^ Jumdkv, unnnu> mhjuuiing rl>Kmr iritl ^rii^ 
limo^ tcniv NUiiMDUL«a|)cmJly diplitlicriiL la wlildi no tloubi tnyuia^- 
dilB i* Rfilty ddcfly accoimtnbk. In the s> called Slvkts Adams 
Mfm^me a bndynmlbi k »H>daied wtth qiikptlfciim. i^CT>paI, or 
■pcplpcrifonn UUckf. Aft rttjtid* ia occurrence m acuIc Infcctloni. 
4ufifig (^Ithrr ibe utivt tu^ or rMvak^mcc. th« rule mjiy br l&id 
tknn ibal d«y JKAf^n dm/ deciM dr^f Mrw ^ ^p^rrrjuJ err ujUtfJ rtif^r 
Mnf«» iMJMB«W 'xitk itisit it fwJ« m mutk. ij net mart mgnttlivt e} 
datt^ and «■/ mted^i iftdai waltkfalnta amd can a j wc«£J A< cjKVr' 

'ml mica 

Tin Hf 14*1 
luff E<41C(, 



nnicju. DucNQflis 

[rrcfiiUritj uiij IntonnittcacT.— /rrf^^/oriiy iuduJo wiMioi 
in roJume &n'l ilnogth a» vfU u wxvt interralf; thou^ the faiaw 
4rT bct^i drvziibcd by the term uaa^iud; hy imkrmikm^ b ncuU tbc 
omkokm afboU^ mid tbc twocttodHMiunrc ofUft confounded brnusMi 
And xiiidmU, The Ktcthnvvipn tkom ihxi intamlt' 
Eotcy cn&y be due ctllicr Ut ttirflkk&l or^bfcnt syscok, 
HcTtb oonditioM mty b« tNoponry &nd trivltl tnd due 
to purcljr ruflctioital diKarbftacc cr Uk iempotnty «C' 
tiofi of A(ti ftubtUincf* A» tobiixD. t«« and co0««. In 
ihc abatucc of ildiiille cllnJcnl findinsii UiHr tignifi- 
cuiec 14 tAi more vriou> in middle ft|rcd. cr cIdcHy pcofile ihaA in tbe 
young nnd \vt\h vnrfatlfint mlniLi of ^jhdJvUSmw trrrgutitrllty it 

7ti(«iKy (d«lmuin cordis) tmd may bt tratifUnt. varifhU, 
fimiikmt vr periodk, A 9tn>nK Ijcat mjiy alicnvUc 
Kith « feeble one i ^iJfia a^^m^iu) or double or iriple 

or, the normal Tanatton ihic to deep iospiiatioii maj be fO ciMVcalcd 
aft to nuke tbc ladkl piils« wnk or icnpercqiiible during iupiralta 

Idion^cfDcy u jj fflssilt* jaO^ and tlu grtiittsi ilrtinkMiid btlati 
upim tkf >rj;ri n^ Urn inHMuot /md thr. ffrflMtMtt 0/ atrkylhmia 4J ««n- 

Inference from Afrhyibmln.— Thr following ^EnUtf nxHiMoaa 
mtMl be <tinMdcrcd in cvfncAx. fi). failumtfampensitJionm heart 
kthmj wiiethef due 10 fljIerio-cdeKiaki. myocftrdkttc^ Inly drf{enctm1ion 
jr oreri^uwlh, sicutc diUuiioii <:r vulvoki di&ca».\ (jV CfrAiifi ^fofci 
a] tK^tramai duta^ cr tUtlHtiKiiuti luch tit ntenlal oveewtjck and 
tinm, cmbral menbi^is. tumor. Edstca, »ftEiiing and beannnfaap 
or actual cranial injury. Cj). Sexual tn^t and tk^ at^ust of ^koM. 
£«& lofjrt and Ufb^rca. {4). TJu kmitfi 0} rfiJAM« mch a* jMieumonla, 
tcarlatina. diphtheria and typhoid. {$)* TJk wtf-^Oiom «/ dngi 
<uch oa aosnlM, bcUadcnna. digilalia. a>calr< and raoqthine^ (^). 
RrruJ JuGue. Kxvpklhainu fuUn, ilie lerminal Magoi of crMfiun'iif 
aitmtnis or tarty stages of kther^taUsii in which howcnr npkljtjr and 
an easily ordinhle hrwrt arc rhirfly obarrved. (7) Disi^tnx dKa- 
fur^nut tx^KfiaUy iLok attended by flalulcncc. 

The pjvadaxte fuhf Eft moM frtiqiutitly obmved In encettrive rifdiac 
vcftlinca. especially if usodalcii wilb obstmctive pnnfture aucb >a nuy 
bt exertvd by peri<nrdial dhieion, roediaalinal tumor {whe(h«r ancuria- 




^ftUdnUr or inafc|^uoi), ladurttivr [TKilJAj^rEnjiM or laiyngntl, 

Of bvuDclul aUQiceu** 

C«ier aod PuIao* T»rd«,— The finger* aoi* bctin slill lh« 

ih d^ffdOlbftlrs A wvfT or quirk rtsr j^mt clocoit (jiubus 

fdcf) fnxn iImlI of aJi>iv h«c and fall. The fomier 

U cn«ptiA*d bjF iba w&icr tivnmcr piibe of aortic 

imuffiotncy. ibc btlcr (pubuii t^rtlua) by l);c blftb 

tCMion poke of kiten^4dcraiis> inEmtitiU Mplirifij. 

■ft|^ pccu^rU or aortic atcncaia. EiAd ^luJlly )□ the 

tinw ol riM »d (oil la ftomc^tirrtes noted in thor^if iincTLmm anct SaMi 

ri^ll/ aSimu ihai rrrn the Angrf niA]' dlfffngufiih bctwmi the pulu 

Uitt is ttic* ia iu ttccai uad iaHu* la iu dnccot m Jn Itsacr g^cn oi 


Foil PaUc.^The arlcf)- Is fall beiurm Im^Sj aiiil may be lui^ or 
intlll uid of hi^ 4>r low ttfiiioa, 

L%rgp PuIm.— Thr aatfsiifn of the uler> u timrked as vxa m 
aatk tcKur0Ui>on (puknis m4^u d ccicr), It mny l>c fuU ju in 
fmwT (tkMMcf^ ^'0 iKit t> usually of low imu'i^ Puiiut r^iirufti. 
ThtA b trpoficJ hy the urwiUuned quality of the water hammer 
p«lur. \tat to in miirul »tcniKiB and citmce mabntrition. Barren angrmiu 
oind ncufuthoilt. Tkt Smail PtJu. Aarik. nnd nftral uteooui. my' 
ocanHlii aad onmrUm futnuh the beti nuunpteai. The Ihrtady or 
f ww fcf fn/tf. Tib «nMl1 eiD|ily rajiid r»ufM i» » forerurnr^ rif dralii 
in mo«t BQUaccv- H'v; ^aJj^. This jmaJV fiorj pular a bral marked 
In poJioaAiL 

UnUsianlly Weakened or Absent Pulae.— UniU^enU tttard^^ 
tioa, wtflbtefl, or eniinclj-^iciH points U' jtrufkiie. oncurum. tfarom- 
tiOibi, taibolbfla. ■tmnclfl^ Lir tbnofniMl after! a] liiAliibutkm. Ih 
amtt^ism 4f tkt ^u^uliHg pcrUon of Ihc arch invc1yiri|; the innom- 
inate, ibe rl|chl rwiiAl md carolid arr iffirdefl. in tineurism t>) th4 
d v t mi ing ««ffa the Icfi tiirlUi; ar. a delayed pulse may fl^*?cm|.-aiiy 
wieviHm of the InTuwnr portitM-t Tm nn^A tciiaft-:* ih^ultt vtcl bt 
pl^ud mfcn this sifif e/ oiMurMm ajUii of4en Uitkini or u-tf^W cajJ 
H^mfi^mu, ixm of (^ pcJw at the ankU nmy he aMi>ciated with in- 
1 BiUimittcut datidiailiou ur L« a (.iretoix-r uf wuilc ^n^^ie, 

Dicrotk PiilM.— A teamed beat or cchi> may be felt more or Lew 

^^—■'tlx ajcntial priiuur Jiifcrciicc in any uuc a « KCok pcrtpbrml lireu- 

]tt>#«C# Hi 



Dto«et Me prevntr. abnom^dllT oofwtHcied «r d«fonnrd oppriioj^, or. tb* 
or panisl o ja fii faa m iatflnnitttRt into continuouL Aa« ^ >Xa 


MMDvukt mAGMoao* 


orta 4\it 

I svsi. 



Term* vn 

ditfiibctlT under pvoptf pramre and tndkade* ordnunly ^xtnoM 
cdttuiiaD or icozmU- early nolrd la Ijpbokl Icnm ftiul tbc tjrpWd 
MftlCi btit often fouAd in c^siuijnf; ^fvucs oJ vkriout soft>» mA hnllli. TIlffCaptllATy PMtt«.— ^Jof ^tiincrate 
<d^iUary pidiniHvn. It is « rbythaaic 
*nd paling irtiich Tr^^y bp flfrf/mri over \i 
niAlfin jucu. b the mftliii <4i miking 
r.c ij -i»«fnii.a pPMmireovcr Ibc naiLorm the fcnbttid or 

««n. (ic by nHilminf thaikto by friction- B|^ 
■Itadily prcttifig a jd«« oUJo or ov^a Ihc rim of b goblet upon ihf 
muroiu mml>nn^ of ihr \\\^ tn rhythmically fwrllhiing bontrr k 
rr«<tny acni And it Day c^^n be ohtrriTd tn ilic mkul aKrrics. /I 

iX^pfUktUmk goUrr. ntttroith^m trkh •namitt. C4ft<iin cum* ii/ .Wtor, 

tliedinicun blood prenure may ocnr be nvoffurt^qukkiyMidexAfltyby 
timplrafifl nlaiiTtly inrijicnKLiic iDMronwslvaeulytlloEvhkhdcfiCBd 
upon the Mine eciKrril i^iiiiu|ilr^ Ic. the (fiiiitUtJi^n ol llic pmauiT re 
qwnd loobltlentcthoajlt^iLtpuiwintAiheljo^bitof & niBrttuy oolumo 
banun^NUdcr tubt f!iw%-58)- Tbcpmialikuk^injiuemGd Jviewmj^ 
i» occuimfc and pnctiol bccAUK cf its broad onn piece wMdi ucduda 
lh« irrmn (hi^ nMiImp) tnhirrrni in th^ tinirrnp ccirrtprrtsiDn bnrKli 
when Applied la i,uiuauAlly fat oi niuii- 
cuLat Atmt, ACd be<aiise of lu accurAEf 
tqeulAlbo of istwuc by A alupLudL. 

T^clul'lU*.— HiJ- hollow umli-l Ap 
pUt'tl miJwij' betwwn Ahoulilcf and 
clbovr !■ i&flativii by the hand bulb until 
Ihp nultAl piibc b loAl. then by Tlie 
outlet thumb screw the pitaaura h 
litwtn'i until iht puke rrtuTTi » psL 
pC!n.t[itiLkH Ai the prcvurr & cqiul in 
aH pAft* of the clooed »y»iMn iht bcj*^t 

of the meraiTf rnliimn In The nunnmelrr tube ia an cmLt liidcA whI 
theKAdinKrcpTC9entaihc"mdfiiwiHt"or''^iA^»<"FrMUi*. ••JWof- 
iaUe" Of "niiiimuni" pmaur*- ii dnrnniocd by nolln; for inn or 

• Kot*.— Th* multr i< refrncd lo Thncton C- Jm^wAy^ AdMnbl* 
mcBosrAph IPt An ci^tfded diAcuvion of thU lopic. ' The ninlcal Scudy 
4d Slood FnouiBL- 



twin pulaiKiont iht bcnulnj; lunplfniiln of tht piiUr w>v« itgit f w] 
bjthe sicrciuj oduatoiutbeprGeunjUrrJuccdin 5 nim.Krici. The 
pont oftUiUf nmiiBilUP CJKunior b ibt mJ^ fi/ duttt<4ic prtaruff. 
JUkfw ihni b tt Hmited inmurr ^roi of ttiual ninjiliiuilu. The * ' mran " 
piCMurc rtpntcnb the livcrmjce of srptolic aii4 rSijulolic rcndlniBL 
Dfwtntfc n^Aiaf^ run jkbmil 3%'4fi hrlnv KymnfEr aji^t ^ Xnvi \rrvi\nD 

T&ry 50-lb and ia sonic rc^uiicitaliVju 
up to too mm A boce b«nd or a 
jiipiJ or cxcnuivdy rnnall pulx makes 
cImiioli< pnsBurv dcC«TminatJon impo*' 
tXiik nnd tti rvrty ranr ihc Ann hAfiil 
iJiould be cToAcI^ »dju»icd, Ihc ftm 
njppAnrd m ihf hr«n WH ^n/l iTi# 
bam? pUftJlioD tftkcu fut a »?iK:a of 
irUt. Tht Hmii 0/ ^rrrw in ^aleareims 
arkna is ttU 5-10 mm. j«d u nffffigj- 
bk w «iinJ> Mtimaiitd. Tht Mme fic- 
urtx rfpmmt tkjr HfffTfK/t hrntrrni 
Jrmaki titid <,ritaSes and lf>^ it-mdinx y 
ond tiiting pcsrwre. ]n rmrmal prnmrf 
fcur factora »rc conccmeil. vit. : — ik< 
inmal kt^rf meri^. fmphfral nttst 
anct, Uood vtAumr^ and iht diMtyiUy a} 
llU tvAMb. Th» nomat nedini^ occonlin^ to Jari?wA)'— for 
yova^ adults. 100-1^; cAAft silnln, 100-145; chDdrrfi, 90-119; 
billLntt ttndcr > jcan* 75-9^' Ejidtcmcnt ma)r cauA« a mc of 40 mm. 
sod concenmitd pbyncil effort a flight incrvsur. 

AtnormalLy Hi^ Pnanm.— In t^j/^oitk hkrsHtkl Mpkmis ibc 
olcfnenti of iWiio-aclcrosLi^ hinh pehphcnl rettstancv and inttvaacd 
btail enrrgy brin^ aTmut ItJ^h miliri)^, Th }iIinnrrTL«l n^fTTous ndre- 
nent tttnporary h^h pitwurt may ht obocrvni. In accondiiy m>«air' 
dflU ii'tA stt/tdaUd iwifrvt-tdfriisis. tht arrmic a/iatv. \r^d polKoning, 
fDUt. certttnJ hcmorrhA^ und aoEnetiatt in poftm-UyrnaUrv^ ncphniii 
m taAj MuU nepktiiii hi^ Tradisp m pmem. 

Abaonnallj Low PrcMure.— The kondlcknu g^ylrw the luucai 
rc«dJCf9 af« jAcvA, caU-ipst tMhd coact^ti k*mffrrkage, Irt vui^bnn- 
onftsfv attended hj ntnmta rcrilfmrntp knr. and a])TirFhrn»icin the 
pmnuv u rn±s#d. Tk^ nale rtl^fJiofu disMsa. antrniai aii4<tKh' 

Tll«Sp]lT£mo£rapli and SphrEniOgnun.^Thc iphygnLo^f iiiilt Iiua 

n*. 0-— 4i4n«i*r'« lonnm'ltr 



Sl-> Alt! I 




UEDVCU P1A0lfO«l9. 

untSoubto't v&liw in amncctkm vtth pula* ukffig. yielding 
dufclxmB nxirv importuir lafomuiuxi than nux be iktircd from 
and EMking d detiit^t a pennumt iccovd. But ilLhoo]^ itt imt Jm* 
Aal lavnJTT nucA Eimr- the JeUiioa of tlirc IdM (» iJB^^inwa tf wi ^a^mJ 
Bttlia It unlikely ihal il vrill ei-er be cxieiuiTely L«ed b cUafcal «oih 
OUttMit of hmpful nr (onnilutlnn pmrlicr CfrtaMy ii taitttM rrpUa 
«r4inary pmlu hhm, ti f<>r no other rruob ihsi ib fotlufc to obtnr die 
*!■« of « pulM, 4iid lb« ttndlUoQ ctf the ■rttri*] vtll*. The Iciims «l 
%pbvKinc>giatl] to meat coznmoo u»c tn ihaoc oi Many and DtnlfjKn. 
citiier oi wbicb gtvs ac*U«nt mdrgr. A dcUilod dc»ci4ptien ii 
uniioccvftry, ihc principle of nU ipbyKinnKniptis bdn^ lh«t of xht tnu- 
doIhIod of ibe pube vavc to a lever >« ftrnnjg&d » lo Rgietcr ibe tsau- 
iloB of thr mmpvrfuJon p«d tjpnrt wmi^ subtfancc *udi n mioked 
p^)er which ii iiaun) under Ihc point bv dock rncduniuD at a kitvvi 
nee per icrond. ffc* di^ralAi^ oOmding tht f/vmfiiM 0/ Mcn 
moifj and lAt t^or^ 0} ikt 

taltitn Adw iWn MndiJy Hdf - 

ffijf«^; h Kttlc pr&ctLcc atiffi<t« 

antl the ili0«rrricn in rT4ulT« 

anciuiit wBTCOt nvloobmire 

tbdrclinkal nlue- To makt 

pgimamfU raoinli »gfcdjil 

paper may b« oblaiMd of a 

tmmth. blghly cakndand 

Miiice whicb la tibMaXy smoked f not xorchc^ over thr f^nmr of 

CWDpbor or even an ort]ini.ry eandte. Tbi^ afi«r iraiing the 

of tht patient and the d^le* is ^ippcti bto a nktmt of pbotogi^ifa«t^ 

varniBh or tloiUu mbstAAoe and dried, Tfa« insuvnwnt may be died 

wjib or wltbdut tbe wiisi band bul i>ie hand must ainyx be Kupport^ 

ai heart Uvft. Ucion aiutin^ Ibe deck work the pad should be, and 

rrmai9. encHy owrr Ibe aitrry ard the TnlUcil krad tinned unifl Uw 

ncedJe >hons it9 maximikm aaiplitui^c <>f mo^cmont^* the hand jtsdf, 

di^lly dordflpicedp ibould re«t tl^adily palm upvard. nith tbc ficfien 

lUfbtly bait. 

Spbygmo^raA.— J htanatyns 9j aJlira£i»/£t dfpmds ii/«i a ikar^ugk 
vmUrs/atvUng vj ih*it iij thi Rnnnof fiJu- In (bn wr iTttiKUtcc an 
anatniU or funding lutt which at itt summii ov apea btcomca the 

* II b ttHjUly best to nakip Mtml iradift imdn- rilghily rarylng pirv«. 

|*^t. •»,— Mwf '> Bpll/taiotTilth, 


tux irKAirt.Avo plqod vi»Ki4*-?sxsacru^ 


ii;iiKrE<«P( IV dcjc^ndMf /imfr. Ilie htter being divided mto t»o diltf 
wiv«. Uk higber bdcs tbe lidol cir pfedkr^kc^ the luwer the rrfu*/ ^r 

ihe tom idfcag limb b s bdlkiw rcpncBxiititift the 
KvUc r)o«uir; Ui4 aptt kngkt sh/nt'S (he mtax- 
hrmm excarnffn. ib< twv nafttdary tUvatiifiu an 
ihe dctoauting limb Iki rnuAriv GHt^ntttm^ M 

Rormal trACtngs aIiow a ncoH; vc rtin] up- 
ttjokr of nHKiemlr iiri|ilJiuitiT, n gradiul dtiopiir 
and A mo<kntcly ahaq> ipc:i> the tidal vrtyt 
bHng inull. thr ilicrulic low buT wdl mariiod. 
Abnomuil trocinfs abow;— <mV jfn^ji/ apas. 
n^ iMdkMci hi|ih Iciuivt %nd a ilronRly [Ulicj; hcvt, aortic BtcnosiBk 
wnuiiB. or too ptzi pranra of the p«d, {bV An im/uiy^wi^ vAdr^ 
tf^ ioifintics low tcoaioD, >Ad it 
npniilly iiuricd in uttic rvgur^Cft- 
tioo. (c). A jAnvf HpslTiiXe jndkat^ 
!!■ fi • — gmill Tohoac: u id miLral rnrunDta- 
tMNi, sDcunKn. aoftiu McflotA and 
utcti4y«clt>0iik (d), A img mptM^ BSMoi Itm ^'Vt?>ii'^** 
pnfpbml drmladon. ihvp Sfffole, or in pmeral. hnr tmian 
Aoftic rtipirpuiiaa funu^e^ u iyp>cal 
HtmplF. (t). fn^iJtiv rMi^uity t>f Ihr 
upMrohcc point* li> alow £PinK Ljf the 
Hi «4.'-i;*Jif' arttiy «nd U Mpcd^lly T!L£>iictcl m miinl i ,^ ^^ ^ ^^^, 
ltn..rcu-«i«* BlmooB oi iTHui)p'Uit»n. Arlai..>^. Icr^ "o^rle™.. 
gflCUlfaBi or m wtokerifti Divorardium, (f). A vtrhcjJ ufjfroke mdicata 
[arflfr blood volumfs and <[uick tjitLilr 
nhcthcr «lTuri|[ or wtak inJ ta cicmpli 
Evdhj Aortlr rc^rgiuiion Ig) A mailmi 

obrtnidice m in sonic Alvnoftia ortitono- 
tffemdM vith a vmng oinliiu: impiibv. (h). A damtHv/M lirfa/ 
In^kaiEi cardiftc weftkn«». e>r, t^mgih 
wUh t^kud pvriphrmi cirrubiion. u 
^nilrftl or «o<ticrtKvnEluiun. it). Marked 
dtentlif inivf poijtu (■> Uiv tcn^krn at Ui high 
lensoQ nilh cudkc wtiiLn»a> Ii ia beat 






from Blink Rv^i^utkn ihb poinu lo «fi cbnmftod drculMka itt 
& strong aysiitilf, Le. aiwiuinn, uierio-«cli<FcuiB wid aonfe 
Aijil« fiiran tfkfsp poinis. amgm^antia m tke Uru of ^tsemt an uMfd 
in mitnl lf*Io«u; irrtf:$iiari»k4 tj iki &w« JiW ou- 
rrfpondinjt lo ro^iiniUon in d^rtpMet of bay forta (if 
Irrrgul&r forrdble bvcMhiniE: tnd tn^ niVm^Bmcy. ir- 
rtgaiariSy cr l^tntffjiilPU to ni*d« diwly ei-idtni by tlit |.^ tt.~M- 
Indng*^ Tbo pUlA acconp&njfng Ifds wciicm deariy "'****»™b' 
abDW llie chorMtcristkB mentioned in i^ Cojicgoukit pttncvmpli i»d 
ft wlU hrr stA that in citerva- vIm lliorou^iljp timfenundt Um fttto^ 

, tijilo Lnrohvd Can obtftin bkfotouEkpn oJ CDQiidenblc ^^"jr''**'^ 
|>n>gn<Miic uid tfccnpeutic raise 

VEKOOS PULSB,— When diiiliiiguuliin^ LrlAocn Uie ph|vUQ|it 
iM!]^d/*M /w/fiT ko-i a pallialogic ^nih* puitt th« abemoJ japiltr tt 
ihr TrsBpI usubUj cuiddned ai lidng imai viprr^dnl lad nrcciHih 
Tht nc|cnii>x pubc diuppcars ibnvc and diininlslicA bclo« Eke 
flngrr mmprruing Ihc (ruf-rnal and intimdi jtigular vdns, or, btCln 
sUH bodi ibcac and the lubckvian. and b aiipaieati; due, ao< lo £nct 
rrgm^UtioEl of the biood. but tbcr tnrumiKba of a suction «v« 
rtom the heart Id iht vtm^ Ndlhtr U it dqmdtfil vpon dntrufdoD 
L>f t])c vtnoua vnlrcs oa tc» duocticm coincidca vith tLc notmot 
How ihron^ xhm. nnr inuiKmituul fmm thr artery, t^jq^ ft woolil 

I pcnplicndly. Coincirlcnt apby^i^raphlc tracini; of ibc omtid 

I poUe and lb« negittva vcooui puis* [m>v« the Litter lo be dkAofit 
By t^ aojne tnetbod IW MyMk veno^i puise, prut poAlii^e of tricwfiaci 
rci:nrF:iiatioA. U slifvwn lo be a lysi^Iic r^j^urgilatU ptJu. It b cLidly 
ap(>arrn1 In the bulb, IIkh]|^ ocrmionafly prriphml and In fitimnr 
caaca, c^peciaUy Ln children, then i» f-c»tR<*iJntJ c^^iMtfilr pt dM Htn tf) 

, fjt^tiiwasavholr. mEUiciJiLly rrcipiiii^tbypladng «n« bind upoQ the 
dgtl lover llioradc xoac pubtcriorl>, and ihc olfaet orcf the cnlar^vd 
liver m fn>nL Tbk maAttuvi« ja neccMary to dimiikalc the apuHoua 
tranvnIllFd puljalkm frequently obKavcd m cajdlac dttatalian,* TAf 
^Wiit^ ttuj^j ^ii/i' if /0;l periphtraily bitl ihuj^aW ^ inimMiM^ tm- 

iHaatolic VCDOUiConapec-Thb rare sign indiatfr » eattnsirc pcii- 
cardioj adbfu'on an.1 h due to diutolic ncestioo of the diecl wait 
luconipamed by di»kilk intn'tborack suction, la appearance il 
resembles the poailm (syUpolk) venous puUc> but uodcr obliteraUni; 

I *SahlI tepona a case tit vthkih Tncalknl biflaaunaiuiy pukitlon al Ifae 
I Ilea ocoirttd ii tbe leaidr <d a »vpuraUvp UiolaaKiti*> 

ECAUDunoir or 



prcSMVC tfic wave Ea cmknUy dlminuilioJ or lovL* Compnavion iStnJil 
iftdwdv botli iDtcmal and rxt^mil ju^u vciiu in all atlemptt to diU 
fennliale cbe venocM pnlmiKiru. 

PMiti'VB PawtiBtui£ Venous Pulse— Very rnrd^ oricI usually id 
HJNviatkii) with a ra|illbii7 pulw a piilfiaitnn riav hr nhu-.Trrd In ihr 
ttnMinal vcsoua ndidca. Coiopnaaion c&uMa ccBtrat obUkntJOfi 
but <lo«| aot afl«ci th* periphn^ porltoD, 

Otfaer ViaiW*Re5pUalory Venous Phcnoineiia>—TbcawciUng ol 
ttt« wiu of Uir beck (iunni; liotc^nt iimnm^ or nuuining a mmicftl 
aote ts furJlur lo eveiyuuit ao<) U mn bi alt fnrmK of acvcrr ilripncnip 
wfactlMT lonporarf or pcmanrTit. In dirontc condilii>n]i the ova- 
ilbMulne bmnncK prnnanmc and tvra^Tmiallir ihe tinuaL intpiralory 
4inisntfiiM and txfir^icry ftUltHN is mcncd. in which taac Eniluralirc 
mcOiailJAilM, chronic t*ricanlilit« pkuritlt. anmrifm or lAj' other 
fonD of OKduuMuid hi>Dur is suEgcaUd. StudcnlB oftca find diSicultjr 
in dktinpiulimg bcmrMn t4th>ur puit^ti(m of ih« inUmal jugulof 
imi eaniid fidMkn; ih^ jvmfr an/frs a ^Jer arat ^nd U mmduinttory 
am4 ddAtfaSff in <har9ckr. and prrnvrt i$pim ike carvtid doet nci 
cfttt il 


Iit^iectuiii-— T>ib ihatilA he both <1irvn and tan^nrtal, ^n^rrvl and 
locaL Tbc nooC EnporUnl n|^« an : faV Tht vc^thIo* 4r«iM dcK^bcd 
on pa^ B^ <^), Th* at^mttfrn'im and lilt neighborhood, {c). Tht 
oroa iymg fcrfntjv 1^4 ivwr fd^t vf the ifjt napuia and the ipinal £bI' 
MHH. Ot mk« chiefiy to nokr— (a^ Abnormal /tfJjoJMW, (b). 

Tlw Apex Bent. Thn iht-M be rtprcKrtlcd by a Kcntic rhyil^tnk 
uplifting of ihc Afih inicnpacc m an arra not more than an inch in 
dJMftrtCT, wrll within tin BuM-ckvkular [fnc^ It k not alwaya [ifTTcnt 
JQ hnkh. olhfr becauae of overlying fiE or an tntervvniitg rib and 
the bc4l u often cvcrvd^ r\m b the cimr of a iiumkiil bcmrl, beauftc 
of tcmfmnry «xdfcmcnt. eirnion, indi|c<3tion. njircntiaiT), ncurulhcnEa, 
ttc A bttn ihnr U abrnvmallj Jitrang hy munn at hyprnroph^ 
cmuet A dEMind ami «idc fpTC4d Ac^^'n/ tujiljftinic) laipUvc, and 
J*0 JkMl 0/ 4 tedfy dUal«rf Jbort fr «n»vj', ii^ur c"<f if^dfUttHiKcSt. 
In dtbca oue th« vm^ polflution b grently incxravx]. Tbc Po^ 
tiOD of tb« Apei Beat.—Abnonnaliiic* of powlion mtui inevitably 

* The uitlur ha> lAacrlnl thjt tlateincnl bccaoK d' the wei^lil of iiutbir- 
fciaim opcoaoQ bni bfttguiii il to bo tnbJKt to c3cc«ptioQ' 

(.PHI mo* 

Ktrr lor in. 




HznicAL NAOion, 




foUenf d«cid»d duaBn in the oidiu otOHiw or Actual diiftl&crnNitf 

of (ht hnirt. 
I DUplacemmtof the Apex B«4t.—C;^t«or^; (•). UJgb pooiboD«( 

i^litphmsni. (h). TyiTif«nlTM. ic). Andt««. (d). AbdoniiMl pnwtls 
; (c), Pcrat^nlilia «iJi clTuSLon (often it nipple kvd). Vpwofd mtd H 

lr;i:— EfFtialon into n'^t plrunl lac. (ft). Liquid, (b). Gftnou. 

Dtrwfvward :—{ti^. Aortic ■Acuiiim. fbV McdiiuMUiAl Itiimr. (c). 5c- 

nilttr, {<S). H y pertiiopby of Icfl vcvitriclc-. fr>, ColUpM <■! ^bdora 
' iiul vkcenL, Tv right or irft: — f»), 

U/pertrnphY and ^ihliiimx^ <h), 

MC-'LC. pneumothoTai. hydrollKir&K. 
ctr. («y UniklFn1«inpfa;«enu. <d). 
rieuni jtdhnioo ami rclraclcd \\^Jig. 
(e>. Marked ulij tnlujcvmenu nd 
liaoK ar of the !efi IoIjc of t]ic 1i%cr,* 
The ftpM bMt majr b« InvUbl* 

fry frvii^m r)/ — (a) InUTj^lion r4 

rib. (b), Fnt^bcitwall (c). Feeble 

bcut. ^d). Kmphyfcma. (e). Kdrmst^ 

flfdicaCvaU. If). Prricttfdi»itdTu6L0Q 

(ra4rktd)H ^e), neural cfTuAH^r. (h), Tiiiririfiriifilin nt itw tI^wb (ji 

pcBonl on n'ghl svic). Its area and appuvnt fOR« nqT^ 

iiKrtaMd b«<im!t oj:—(^j. Kcrrous csccileniml. [b). Bjpnlrofilvor 

diktniifrti. <*:!, Rrtncrloo of lung. 

Systolic ReUmttioo.— This u^y re«ii]l fn>m dilated hcait, old 
p1cun>'pcrir3J(iiAl ^Ihcvirui) or* thrinka^ anii contnctioA of ifac Ml 
iLin^. Il a utic o\ the iugn» of adbolaa of the (^ric^inliiini lo liir linn 
iiwli, whi^h i:BnMa A lyilolic drag upon thr iliaf>hn^ but to bo of 
idiognoA^ v«lu« m thb cuoncciion il «hou!d involve the poaierior inlet- 
vpKt* as well. 

Othar Pnconfial Pululloni./— A tfmn^f aittfig nenmu heart and 
tlu'n diQri wall may isuac h^'aLuUc pubtcioo bl tbc lliirdp foitfth ov fifib 
Left interspace and rn tLie upper portion of the «[ngutrium rr«n though 
Ihc henit be nprrtul. but ordinuUy it i% ussocialcd mth iViSv 
dilatoiJoa, adjae<til pulmonoty cavity, pulnionary 6bnMia» emphyaeou 
^i the lamp, afi»mlu, npiinidbmU or «irvs*ive erai).i^ijui. 

Pubation in tht Recioa of tbe Maaubrivio.— Sudi an impobe 

»■*# 11 

• SlNPtnJfiry lasvaj diiiplacfDioat may occxAinnftU^ be ttidmt In rigbl 
■!ded pleura] eflUiiOA Sco p^ Ijf. 

Mr JjtiffOM J4n> PKvcusfioir. 


Ef aaifcod d«rmr< nCT*''' lacuiisii of the «ox1ic ti^. Vhil puba&n 
od tb« nuaubcfuBi ft«df b ol qiKial ligpufictnoe. beam* of iti o^mo- 
dRticm both willi vncvrum tnd i:enaln tocm% of mnliAitlnal ^vih, 

Praeofdill fiol^nc,— A»de frtrm the presence cf cwluaJ ^^rawthi 
Mt b utuaDy dur 1d hdf of tso miin. vU., nonfr Anniriflm, r^r, rTirfldvR 
cakiignBcai of llic ht*ri. Ii a most mftriod m those casa <iti^Utia£ 
in ««t7 cUldhoori in whiih th« growing OMfotis Btmctun* tmvt yMd^ 
readily to Hx prcwore bcnnlh. One may then often Bx (he date of 
th« hcut ksatt AtA In adfoflcnl lilt, and &iid perhapt^ thit tt has 
ciktcd kff m WIT century^ 

Pnlpa t io P i — Pnlpfttioo ttm^ bo c«D£rm inapcctkm ftnJ t<» ddctl 
Urflb KUcciAicd whli twlnlflr Mofift or vunniA, ^dfiui 4/ trnJnn/st 
*»d the foicni cha/«ctcriilio of lucaon ol toy kind. It U ol spcda) 

ia1 iiimair. 

ScH>[»f anil 

r-a, rj,-D«LUdUn(i-riiti<(ite |icr- 

fiihK bi cvniieciioa with ^Kpattsile pyltttH^n and diashtk thoek of 
■neiulan »id the prtsfsHtUt tkrili iixd j^jf^^Jtc th/K-k of rii(r»1 simoMt, 
No cxuafawdon of the dbu^cd Jicart ii complete that docB not include 
lb« p«lpt1to> of OTth rcUtrri rvj^mi M the lunj^ ti^er and splem uid 
dtCcnuav Ibe ifvcatiuii ol ButroTiun. 

Perc ttMto g.— J**rottfwt is fijtm itvimv ii M' di^fmtial diagnarit 
cf kimiknfmi. One should olwnp pcnuaa fiuiui (he rnofc rc»<jn&nl 
lo the IcM Rioiuai Afcu, Mre » detennining tbs suptrftciftl duhicn 
ukd Mvk 10 dei««TaiM (e> llr dM^ «r ir/dAhv cvdioi iuittfii. (h) ia 
mp^itiai dtd H tth fc) tftc fc*munf« */ rt* rffion 0/ ^A^ <wrtk arch. 
Abdondful dinsttkNl and polnwR^. hcpiiir, or iplpnlf «i^pi>rgFmrni 
KK kl» Iaipoit»a rtcton U the hcut laabourmAL If (irdinAiy per- 
euBM be (ued the aulomiai border oE the he^n ^ i^t uconU^ 




KEDaoa cuotioas. 

Of vnrvHi 

rur tit 


KiUK tbt 

OVtbnod. but b^ »u«culUitory pcftnoion. Ifau tuf be vviy cl<«Jy i^- 
pfoiimatied [mt prmuaiaB and uiKultmtory pctcwkw. pp. 00,96). ttd 
the 9tudcDl Bhouk) accustom hisi««U lo tW toond of ib« Mvnal 
tynipuy of lb« mAnobnum itrmi. u ihii b ont ef lh« mnvl in] 
icfcioiu. In dctcfmlikinK the niperficU ouxSac ana it u bot lo 
mcnco at ita known ccKn and pcfcusa from llial in ndiaiinf? ImoL 

SJ^nUcuit CbM&ca Ln Ptrcixwioa Arts.— Ad Imitm? in ibr jtfta 
of BuporiidaJ duliun may nwan ij.). hnI^tft*imJ a} tht htarl. (b)^ 
Ks^atthm cf ih^ lung, k) Prni^f- 
Sal eSuswn. Chani^ m ihc ihopc 
of the rdaiiv? canUac dulnca luu- 
•ll^ indicate cnlarpcracot of llic 
heart ibicU, fiuggcsi Xht frKlivi<}ual 

dcrijing valTQUr iwioaA (kc plaice 
7*- TJ. 745- A» will be wfn T»ler, 
«HtA <tMn/:<J mtUiafj strvf as 1 
thftk itfm tftr di^gmnis oj tu/ivior 

tind th4 auimi mnwl »«v«r /tv^^ 
thai stfims ddtHaikn tkva MioMd 

■wy he trnaUem4<d f y liny Mlnr^ 

laiinuirf. Uc RhnuM akacwlulty 

note and iuoiliw aay pain oc loidrntas altcadios lUft proociisR. 

Sy[)MI]t!c pfrioBEitie« kir^xampJf, majlTv tocoualeivl over the dvfcum 

Hiid riba juid misljt pmw 9/ the titmott import ■aw u « dla^nodt. 

Att0cultation. -ThiA dctetminca (a). TJki ciwirfitfaw of fib ibwi 
mt^ilis. \\i). Tkd itmpritKtf. jmd amdUkm t^ ^ wAm^ (0- Tht 
teruvm pratwti in Iht oowiU an4 palt*m3ry drtmis. (d>. The ^omMam 
f>] tAt iuitgi {i^mgtttKm, ^dttji, fJSt^tiati). it). Ah w fmaiiU4$ of At 
Mf^ arth. (f). T^ pns0K€ cr abtatte cr/ munntits in th« irHmiary 
ffftfu and arfftiet. The fint »tirl moftt ifftponant conajdenticA ia the 
fW<Vy of i^£ hAirl jMtmdi In fKi^ v^dmbtr axtsa and In ihE rarriiM 
aiHrics. As in iKe i.i4« t'i the luni;- a <i>mmoa nlMakc in the leacfai&e 
of utijclcnu lii^ In (hp raflurr lo driJJ thfns thnmughly In thf nnrmal 
charactcriaiica of. or coounon rariatloaa in. the bcvl vounda. aad s$tf 
dmtt 9ttd fkytkiani aHlt0 iirtf Im «/!«■ jjri),'ffh/ i/ im vH^viiB- u %«rtf 
and do not demiDd ftoirmal hcmtt aosiiit and KccaLuation. in va 
ftlfur V3y can ^at txphim At fn^t^mi fc H m r m le ntogttise iHf up^pw 
moamng of abnormal qmtkty oh ~ 



trnUn a krnt * of k$mi tomtit, rcnHiiom asnditttit vitk rttmt of l%r 
■Bduf jcrinu erf diwc fcjuvu c^/ Z^ kt^rl. 

HBART SOOJfDS.- TtiQ FUn Sound, A th»K-u|-h ufiacnUnd' 
log of the oKkdn oj fTniiiLninrL ami normaJ rkfixnTLiriTkhn oi ihr hesrt 
tottodi b tfaaolntdy ««tntial lo the fnldlijcrnr mlcfprdaiion of hx9Xl 
monmun. A*Aec^ iktmurm^ ac4tnMi^tiim if an lAr first so un4: at 
xAe ^jff Ml 1M4 «ec««T^. Dbcrsiudin^ coofiicting llituno 4ni] fine dis- 
taxtkn^ C0C nuj n^ Ib&t lA^ t u m M ^kmtnU in tk^ ^oduaion of tkt 
fnt t ammi on llw coniiaaum t^ tkt vatinattar uuifi 011^ Ik^. onaiident 
ciMirv »l tk§ auriotlif'ttniriculv vah^t- ll UtWovri that ahncfmaUy 
intmsii atawtiuthm of lAit j£r<f tiiHiiit a/ kfo^i in nny 11/ th* fitvr 
atu€m^tm are9r. indit^i^ am ctrrdcliRf ^^tntfki^ wticthn due to 
mtn toanasfr m ttrmglb. as in h^prrtrophj (rom vjiLviJar du^otc, 
Qcmnu ovmictkiii. cmcmjvc conimuiun of k |xut)]r 61]cd vcnuidr. u 
i« (he ta9t m Aiml ocnott^ M' io hcij^hicTKiJ oncrioi teoiion. ns in 
titrfh>- yl rr m k t^imnif imraliA uid InuruJtiaJ ntfihrliU- 

Tb* Svccod Sound. 'iketftnUtfitn4i$pradv€t4byih4timiMirt$ 
tms tUrtn and itujum r>} fiv cttlif ami ^nhwury im^iyi immtdiaiciy 
iUt i wmg vaiintmliir tcnOroiHffa. Utntt thb iccond suiund ittuM (itiui*- 
filjf ilcptnd upon the micghty of Uir vil^vfl thrnuclvcA ard meAiarr 
Uic ^moiMl of tlwi reoull Mlili:h ia ihc mitiluni of the rnKc« <*f |jrupul- 
•ioa and 1tt« rtabiancc cncounUrtd in ihe anciy> Tbc tortic rahv 
l>«iog Mund. loy fiwr«ai« ^ xfitmJ artnial trmiim urUl product an ac- 
cmlHtfJIiM »l J)w dorlff »amrf soaiMi, mt\ nmilar imre^td Imiim 
9m, 99 ehs^nM^em I*. ik4 fttim^nary fir^hivm it4U rrniU in on atten- 
Jwulwfl of tke puinumary it€*>nd ityutMl. The tk^tr wiU ikfend idf£fiy 
ii/M AW tfiKiVMf ^ ihi vnhii. iht ilmgiJi d/ tk4 vrmHcUx ^mt tkt 
inUfriij fi/ 1&« mitral and trknspid W/fdln* 

Pneti^ AfpUcatloii- -Muoii infamuttion i» AlTciMcdtd Iwxh acute 
uiit dirnik difinur by a i^wiy uf tbc >Briationi tr> ArctMLiHtJon. For 
dUApIc lobju poeumoaia m^tal incniMj b« nccompbAicd by- mnikcd 
accentiMcion of ihc palmonwy icccnd at>iiDd md » dangerous icndcrcy 
to ■*3*ia*Uffc <if |1)£ right fcvlj^de. If UjU diUuiion becomes ctircaiE 
Ite pulnocttiy xoond counJ ti markedly wcikonfJ and IJ incuftpid 
legm^iUlim utxui Jt may tfC nrlidly lusti a aIj^ij of tlic ^iiTat [[ujHjrl, 
Tbc pnbncmary CDnj^lion inddcnl Ei> mLtnl ttc&oau and rrj;;ijrpl4lkii 
im>kr« anYa(u4tion of Eh? pulmoniry wamd tna-ail ar impnrtEiti] 
dUcnotflc fcniufc and aj id p"**""-^"*, a 1o«b af lht» occcnEiutJoo ma> 

•Ttw tojlnl itrul a^e\j^ lode* aft inrmud under The urac fuaililioAB 

01 Bl^dllllh, 




til 4 


bt ft tdkiiu sjnnplan, T9u fni ju idL «i Aonf of «W a^c^ voj k 
vAcdBj iMf i>r upiM4d hy 4 mttrmm in MDlrd n^w^iatiMi, *nd l«d 
urtir sfnuu£i ciuf imtrmfttfiUf IntJ iv ^tevrr Abr ntomt setmd m iki 
MrtK^TM &tti im $kt ear^Hd crkry^ In miJraf jfa-iwjij the Mrlk aewW 
MiMii if Mwlwrf, tfae niljit bdng Accmiait«l uid sharp or ttaD' 
oklnf anlcMBMjkcdregui^lAtioncacxitf; ioaortkrciEurgiutim tbrfioi 
■ottDrl »l tb« apes U obscured Mrf m ^MsAdiifrf mit^ and tmmpH 
rfptfgilatiim aJI uuruU are p^atlj dtanlnUud Mm irfmkvmng dd 

I biXh »ound4> fq?ccully ai the »pcz may be iJtie t« d fit ca edcflUDOtt 
chni Till. frnptiysnuA or pcrirariditii, or> mijr ciggot rnnlltr 4U^ 

, ptaconcnt. In Gttmd phUusi. plcunl clfuaJoc, modlajdittl c^wiitfk 
^phfi^atic htniifl rtf wco umsu McCcAiian or wcilf«. Ihm cvdiac 
dbpllCDUejiI iJiaj be friJiu[ca(ctl by 
the ch&agKl ute ol the audibility 
of thf sountf ormumiurv FvrthfT' 

I rrurt ant <an mIJo^ vi^ Artoanfy 

I atsi^ murmttii ht^ni «ndtt twrh 

jj lA^^ m-JV 'uhcUy cr m pari 4it- 

racM Pkuniic c^iiaian offm ihe 
mo«T frcqwni cijimplra 

Locrvucd Audibility^ - Audc 
iTcan cau«c« alrnadjr given thlx may 
rcvuH if< frum any cauae. the lune ii 
rctnuiF<] from Um haait, asd broca 
al limd cainddA irith a diangc in 
lh« ailc of maximtmt auiMity. 
fg. fihf^d hirgnr adjaanr nr^- 

VBtkiDH Souttda aic occaiiocdly tranatnitkii loudij aact ijicr wide 
by puLnociJity conaoKdaiion or cavity, aiuJ, in paeumo-pnicardiuin. 

Changed in Timbra.— A tiooc may be hanh, Hnp'iif, "^mm^H^,*' 
"/ofld/ " ffr meiaiiK. MeEallic clndtbK b fre<iuctitl/ au<ljblc in palpi- 
ration. n[)pdn11y \i the Mamach be dtMcnded liy ^i Pasiunitt «l 
such qunJilka uaiuJIy mcau ducaK o\ the nlvra or btait tuBKk. 
or, IHgl) arterial tnutnn. Pirul wvndi and a tlamming finl mitnlam 
ahrap palbolo^c 

RftdupUcatlon of H^arl Sounda.^XAtf R«rma/ Aajrf JMM^MvMHf 

and «n# dia«l0l>c JMi htatMs} Ikt ijKdifomttg thtmt rf iWidbai 

t KviTurAcvtrni 

von of Thr hrti uanil, f I*, l JlniuM 

BSMn vuxiimLA. 


^ itf PtgkS CKd Ujt hart Under m%nj ouadaittna thh fjridlfiOAlUb ! 
b to Bierficnxl viih w to proJucr cloublui^ or ftctuai iJivbion of one or ' 
bntli torODdi* Tbe pIxfMMiiffioa ol it<>upteaiioA hai aptlj ticoi <om- 1 
patnl 10 ihe notind pnxhmd hy ihe doavic of ilnuble swingiiig iWnt. . 
A ocnnal ht^ti. \i lcm^^ari\y cventtitkg. mav be the xot of d^jtilin^ 
or ^dfltlqg of tbt luajl miindK; bul b j^ftictaI It n\ny be uM rhir 
beBnn^ a frJufikmr^ i«f«nJ j4>ii>«i <f iri|>lc rbrthm bI ihc apex. 
one tluwld wped Ibe pmrnct of micnl ti«n<jn«* or myo<ardJA] 

ik^ncntidti. GiUlop rhythm a u 
form cf nduplicaLion A/drtf mvr lA^ . 

plainly orcr one taAc (Pirtfiin) Thit 

a usually Aroni^jr njg^cMhc of' 
marked iiK»rYipFnutJon, inlcniirial 
ncpbriiu* cniph}^4cma. artcrHi'vlcni- 
tis antl vVkphUiolnilc tC^iirc. l-'alal 
or pnutultirit rhythm. |o ttl* fhc 
hcnf wuruls Art mpiJ jimi cxjualtj 
<1iitjA[. i.r if as u utuatl^ tlif caw 
tha< h U<1 Ljf |}iG iltflratirritiii' 
rcftOTuuwr, Ihc}' mtmblc (he Actual 
fiTtaJ hcui aauntb anti Ihr ooincliilDn 
hu bmi well fiaioed '*<mbryo-<Ar- 
dta'^ fSifFlf*-Von HucbAfitJ. The 
cxpcTl duiidan tccoKnicts tarkiiji 
nodillcMkVi ind miaor degrm of the uimott n^ific^nc^ and im 
poctuce as mdk§Hrig a ma/W tnfoMtmfnl of the ftwri mxuik- 

AnMiiIUiui Areai.— Thcfoiu' vurfxc aitm ht tuKuItatian ifc:— 
(ly Tktmiiratanm(t:iicx). (2). Trkuipidarrail'-mfThAHttltxcmxtmy 
(j). i'mlmfMfy t^m (*CTOntt tol inlcrciMt*! sfocc). (4). ^ertu^ 
«rM (wniul ri|bl Snirrrrai»t <f)ft»>. TIum prdntt (V> noi cortt«ponrl 
lo Uk cx9ct bolioQ of ihe v«lrca. *Iucb xomf ^ be indudod in Uu! jun 
of a luge ficllmofpe b#ll. bul npmenl the vou lii whfdi IliA souitdx 
of the ictpcctire Tm)ica fjr their uAociiLcd niuniiurft ai« lioti hrjinl 
Heut Hmniim. —A brul murmur I9 ui eimncoiu »ouiid *>\ Cftrdiac 
Aiec tKrtlkif 10 obacwe or p«n^; or wholly rrplace the norrmt h«art 
sound and dUvctJy rrbl^d lo it in riiythm. 

*l-en fo io c»]y la rT«urRil*lVfl urvlMt auocUlvd wirh njxirardick *A 

iifiOcAllBa cf IV mini •c-iri'l 

illt MfUL 


4^ HfllFtk^ 







Vm4a\ n« 


Tint*. iiutJ- 

CommoD SoQiGci of Error.- Ii should new 
lULiEidK jimduccd by in civpnirfing. rumuliuouily bcAtkif beam no 
Mlilom b« 4CCttntdy inEerpr^tciI. Cndcr >uch toDdklons, wrfah^ 
orgiok murmura tt»y be obK&rt^ cr be unpUod m ifTythta; or, m 
mom cummuoly tufjpeu, munnun nuy tw pn«rDi. pi^rHy tnopontT^ 
ID chumcler. which nuj be Aad often are RfEAf^cd and tilled m 

wtik abfiarmat *iu^titujtu>n art txtwtmely f^xn- 

irvtfn. They cdl lur reati reaasuiUKC, llic td^ 

nunklntion of «uch dni^ u di^Calu and Ibc 

bnimJdcL Ukd aftc^>s for n^icntc*! rumiim- 

tiona. -I/J p4iu»itt ihaul^ ht examined if pM- p,^ — ^\r,»r»»f iinf 

siblr. tmth tt»ft«i runrnfrm^ jwrf v.'hnt flWt » ^- "«'»-■-«»--,» 

the rounnuT) ol tcrunpUlKfn arc uaiully bcal «n4iii4«mirnatan, iNi« 

'^".. , ^ . vn «ftT, *< nsTLt 

heard in thr formrr p>3utioti, tboi« of lUfiod* 

in the Uzicr urbllt somrtima. u b the case of mflj^ >lcfH»tk a 
munnur may only appear ni the monicnE wh^i the palimc rcacbM the 
upright po:iiiinn nit'l thfn TTifitdly niKslHi^. The duxioUr mufmivof 
■mtic rcfiibriEilalioTi may be incicAscd by nbisjcthe^nuaAbovtlbcbod. 
nr. n?f|uire bKsk exeirifr Tn mat*' il AUdibk; 

The Inttnsity of the Munnur,— Tb« 
tlrongcr the h«an jmd tbc (um^Yr the op«ii- 
Ln|£, ilkc loLidcr is thr murmur, and j^ifttHnj 
brtfi^y it may be uid, ihal tke hitd€r tht 
murwnar litt htitrt £i lAir pfttgimitiA. CWi 
yicldias »oft muimun chduiDd willi difictclty. 
or ihiMe in whtrli no murmur Upmeni though 
t)ie bcul L9 bcoEiipeuEit, &rc xinioUj of {Xk 
tnoKi scnouj i/nport. The nilc b of come 
Mub}eci to mviy cactplfoiu. 
Aiutouc or U^mic UunDuri.—7'iW m^rpwrt auoeiekd with «n 
*nnia aft syttfilu iti tirtw and ^if}t and bhwtng in thanui^* ow 
itUtm wMy Uansmkkd^ <ind cf< uvdi/y htsi ti^tifi ffwr IJk /iJ- 
memory af4a (toi^nd left tntercoctaJ tfucc), Thvy ue hcftfd Ic« 
fitqucntlj orcE the a^m. &or1ic aict. etc.. And differ front tlx Inie 

* Kwly Cbcj OM^ be loud and bsUi 09 ht a cue of exMUguloilku <tuo 
ID bcnie hemonhoffic KuUtt utccf obttenitd by the aulfaor- In ihiacnetbt 
[viiiiaai« were AULo-audible and 10 be hf«rd -iriih the t*Jt Bcvccil htdicA 
irom the cbr«^ 

SEUX mmivta. 


FW- r^'^AeM9tm.~ 



mvnnBf of imlml r^gutglfAikcn fn th« fici ih«i tbij htvi not the mum 
imunbiSoa to ibc ftjcillji and badt. So liu wbot lusnl o*tr Ibe 
aurlir arra (second rrgtl uilVroMtftJ ipACe). ihcy 
lack thf iruuiniasinn into llie omdrlji ar^d suh- 
dAriun cbiunciciiilic: of true aortic tbcnoau, 
Thrir «uf>risixlnn with Rivrmfa and tlLuppvi^mice 
ijcaicf *|i|fnj('ri«ic ircatiarni furlhcr xrvc (o dU-; 
Brrmtbtf tlMn to pradicv^ Anocial^d dilatatioa . 
i« uocDiiinion. and whca ptmitt. is slfeh:. A few ' 
ca*n of dlutolic hJcnic rnurmuT tuve bMH r*- 

Plew<»'p«ncardiAJ Uunnurs. When rhc ap- 
poirfl ti}vr« of the [ilnin Hnd |ri-ri(»tiiium brconw 
End^jncd b tbc cxicnjion rd a pkuriiU or tcnmrfliiii. a nunnot may 
be pnMnl wluch ia ufttilljr dblinctly (ricUoaal in cbarader. and facnrd 
ben in iwpirnlwn. Thb ^kjinclinit^ cathim 
Jbr m loe.|E lime afier the orf|QftaJ diKiue. muail} 
lade< ihr quKij «Md tnn«ftMnn of a valvulAi 
aniJvna. but oClcni cjoody ticmhtn pcncar^lial 
rridioB /tfr tr^ Ay h>iMTn^ thr tirnth in fill 
iupimtoa ibc Inftuncd surfacca may Mp&ralc 
aod the mufmiff be lo«t tf fk4 ttm mwh^ei a 
nAdnily wnall %> tint Ibc diffcremn:! noted 
im dnp b(talliin|^ may Iw raixb j^rmicr thao 
p^ririHiHt alone ooiilrt tfTiplntn, 

OlIwT Forma of ActUcftUJ Hmmm^n—AMniM-rci^nihfymta- 
Aiiv is a (t-i^lir vMfng aoumur h«arf) l>rti fluring iiuplffttioa and in 
M ^^^^H^^^B l}>e npoQ of the hcan border. Anoihcr canfo- 

^ ^^^^^^^^1 rv^rmKivyimifTaariwCafrktiorimurTntirtilfatl 
^H ^^^^^^^H heard In fuU a^titm. In the tame arm, and 
^^H ^^^^^^^H dc*pAe aulhcdiativc npnjon tn Ihu o^atrury. the 
^^M ^^^^^^^H anchor l3«|ii^iin Ihrv ici U- ofirn rf ^ai fiJgnili' 
^^ ^^^^^^^^1 cvkcc vid. iiDjKifiancc. and hu aeaia and a^b 
J f>i.m '.^KKou— tiiu«d ihem in oBodalJL^ia uiih ihe tnkma of 

pulmnnaiy 1ijbercukitil»< bi>iFi lit iit anik'nl and 
antstfij. and, in iui Incipjcnl an4 active form. 
He duca not (vrftend to dtny, hcnrcrtr. thai wuth a nuirmia oftw 
ba» laite ugfuhtuux. Somv oirknn a^atUimg mmmmrt mty be 

■Onr rq^ftnl liy iW ailflwir orr^ffvdbi Vtif tfwtmlttagt U ftfmicioMa 



p«btlf IM| 


• PI*. 

Maui tH- 
<n[ ur pBri 


■DICAl mAONiwa. 



1^ 'I wo ](llMl' 



httH iking tbc Ut cd^ of Xhc sLtnuim, pulioiluijr, m coPafcfkn 
, rth *ilvfl.nfrd onf^jsffiut Stmn^ lourdi an* hmH cnwr the 
! I'cntridc *l n pedal bctirccn the upex tJid itic sternum lo whkli 
unaubrficiory cKpUnaiforw haw bmn isidgittfL If Ibv 
Louuui] both ail uid 1k|uid aHjWiinif aoondof cvdbc rbythui lua? U 
audible but 10 aiittulatcd by tounda pioductd sn lar^ nnti^vMi 
cftvitiQ nv m marUd ^ulric distcroioo. pnttimthocu and adyaoccd 

ORGAinC HEART HURMURS.— Vifledec.— Orpmic BiimDun 
ni»y tjc vilIvijIu/. irictml, i><ttcArd±tt] or plnnv-peitcftHis] b oc^b. 

two kLids. U) refur(£l«ilf ;uiil 
I (#) (»fr;*iirt»i'#— i.e. (j) ihiiK 
due lo A Icftkt^ or bnrk Hdw. 
And (i) ihoK due to a narrow 
ing of The valvubr openinff. a 

I Hodc ol ProdiKtiwa.— r*^ 

' kewi muit 6t rra^rdfd jimplv rj.^ 
4 dinddt fHf»*p it conslant m 
Fiiiii,nT.ju twndoublc-^hjmhcrf'l 

' Acting v)'nchti^nniiily, Tkey mcy 

ht stirJifn dhfrummtUkoiiy oj 

ra<i> AMrfj uffAt Af Uimgs bittnm 

ihrm. for Nudi U thr fiUn of the 

, dfCuLdon- Pnn'ivjf c^njfaMiSy 

I Jnio lift ttpftr tJi£ifihrrj comes Ui£ hhod from ^ grmtfroitilrsur^iftU' 

{loH^m^ Into tbc ri^ auricle the wpciioc and mfcriorvaucoinr pour 

' iheir tUrkn impun, vftious bk^, nhflc to the left, ihf four pulnowy 

I'dbsbtiuf a cooBlatit lupptyuf bn»;bL ird, antiiaJ Ijtood, ibAlba&M^ 

dergone purificatio& m ibc pvloioiLiLry aii celb^ Ikt bhf^ fMits frtm 

Uu Avraclcj mkt thd vmtrida itmrugh tJu aarinJiMMiMcaAir tafcri. 

iht fiiicr&l on the kit, Ibc tricuspid oa the ti|[ht, tf«d if JAat /i>r£«d (jr 

lA< tWMlriadar ^witouAfn (lyiAilr) tkfngk Alf |hJwfflMry «abtrM*lAir 

n'jrMonifi>t4»tftf(MiHU upxmtktklt. Asbotb sidcAol tbcbcvtcoottmct 

tiniuJttncouilT, ibe nuiKU pRHluced by valwUr dofuit m ordaoohlf 

DJinddcDt and bkndod inio out. Tki "frtt wtmd" (M) arrapond* 

! tc tke ptri&d el venifkuht £^9^cii^m 4ni iht dMVtt ef At m^kui «ftrf 

''Syijtole, Dtcstole. 

Mitrni r 

AftMtc L Aortic V 


OBOAinC BiJUtT inncHtTKB. 


imti^ik9''9K^ftdt»mtrU^Jmp\vhkMifnaMi"^iiii6\t.'* DuHng 
U^, Vh fmH ^ fdtxmUm, iJbf Uwi IW Aim (mm ottMm^kHn£%tiike 
maMa d^M p»ms iffwm Onmik Om optn mUnt amd InnapU 
V4k^ y fUAt tmplUd vtvkuitt. and. jbit Ut^t Ac iietf syOaU Ae 

diakiy fvE^wt. 

PnctU*! AppUcntioa mad lmp«rUBc« ot t Mental Image- 
Fur Me oNutteJOr. »7«lo1t u initialed ^ fAe fiit itiotd jmd dUatoIe by 

It If — riir \iaA*lll*4rlHiSik 


'lv*a*4 ■■yttn*- nv. iliirti *>:•* 
f V. Trfr*!**' va^K. ' ^. '\>4ii« 
vi)%« ft, rsfmvfitr* iUt* r I. A 
Ufa »rvtc. RA. HLrki curKfc. 
I^V lit. ..y«#^<f tfV KigM 

r\ 1 I .. ■ > . ' VirlK 

PA. i*»L um >i>nrt«n. 

I J- .; ( ..- \..:r'iiJ ir^arl *11 111' 

- and Admotbri 

- - - - ■.^. ■-' .V...-.^tJfP 

IIH iii|i|VjrTiLi cTlf 

K-nirii-l»-- ■'■ -i-'-n 

ll|<I|»i *Jl4 Lj|-,r ,|. I !,■« 

qniiVT aiiWi, 1. A- t.rtL «iirutr- 
R A k^rhr tLi.tflr J,V fffivvn- 

VTB#*IV**ll<tfi'". Vrr. VnBCtfA 

Ufrtf JOCBMrf. /« Mr mitt^t tjt %cHvr tk^ tytit cj fvmtts, Thoswltbthc 

vi«Jv« Jh<MlT ^Z*" ^'^^ ^ blood varpng fnt^ the pulmonar\ ulaiy anil 
aoro- H'tM lk4 sruW jnnuf lit vo ar t-ui.( nvuvil uf luiiili'ijun*: 
Ut4 aorlii lanj finimtmary «a^J ora A/^T ^^m^< '^ miifdi and tntmpii 
Jftdy efm and the blood is nnbiBg Ihran^ [ban Fitim \ht Aurid«i 
above to Uk ratrfcka bdov. 

Impovtwn Dtdacdom.— ^ny trfjwte ewfcirfy wwn>»>» jAjj im m t - 
dU^j li\Uwm%. r^fhut or tw^fa At wnnof jWit wvkhd VvgiUi^ 




«|J| v( if*- 

01 dii 


imWAL DtAO>fOet9. 







muiiDur). mtal ariic dtka frvm kaktiii in Ute ilntd tufou (ixltnl »i 

(aonir anil pulRionoi;)- fIaK4 tmj ari^mit mdotmHiel lystdk 

o^Hic OP ftdmtmvy ofttfnwJiMi (nenoaift) /h diail-^ lk4 ^pp^tOf 
tMdiiieni frttnul; ik€ mititi 4fU ln<msfid vtkti brini epm 9^ fk 

<my murmur immtdiaitty /oA-wiiif. nuiJi/yinf > or npUtimg A$ ittmid 
tnmd E^iaMolk) it dm 1# Mrttr «r ptitrnm^ry ktl4g€ «r l# njhaf w 
irittupid fibitnuikm, N4m Mtf a/ ini ■w*rn«n Aum liw ^iripM ^ 
1^ tf^i **arf— ihc hard woriin^ aJr 
Aguiut the Str9(unp--li k nv 

0} tlu hiaod. OH rfiuTAJMrf OrtiiH ii 
ikrtifftt tip<^ Iht tardiat mech-jiritn 
tmd teadfoty fii tfm^4sium tw stash 
it dJ (m<t tjtiMUkfd. Thctt/orr. if 
vty dASunm^ <>J Hit tfcmi U [irtsciW 
nr any poitiun at thv fumpiniE nut- 
choncry v d«lcctri^ Ihr biMi rllrcu 
«JIL ipprnr tkiffiy in ihinc |:«>r- 
Ijoni of the hcftft iifArerlhe vi^ncius 
wnfTft of Ihft bload. /» jAari. IF 
one nuy uk tn old C9ipn=isfc«t. ihi 
bad ^tt jf <t c.trttiiK im^rt timk 

lUustrAtioo.^/i'i'rJli'uif ncphndt niaes Arterial blood prcAUje 
m an titr^nlin*ry drgnr ui:d ihe Hi vtnlrick tt oner n^pnntk 
to Oit (hAllcnfc oi the suutQ^^d ortcH^ bv bicruuiDg the »trtii^li 
of iu coninudirm. Hie hkiod h i)kii forcfd » djtocioiuJy l&to tfie 
aorift u to cuikc iht n^il or tefislon of ilic ac«tic i^Itv tamuKially 
Tiol«il. Miiid M a n«\iH th«r« it &n "df^MtfuaMMi ^ jAr atfr«f£ jffwij 
j^nimf." l.lkr v\tTy otlicr muHli? undrr uniuunl irmcbe. IA« t 
iMtiJj M hypertrophy aaA I0 incr*ii£f iu Arnigtb; iJu ii<At/^ aipJ 
df jA/ futrtii viht is aito iiarraud a^ad an unu-tuaiiindexiitsthvprfjsmrg 
ii 4Mrltd tifim tkf milttJ vaiw^ ivliidi /Ainds htiwetm the orcnctin^ 
ftfilriHc nnd the Irn niirklr. ;^ u uosMknn hAppnu, tt« wafra; 

l**f' C^TrtfV-flfh 


AO, Avta. 

riii\r C9VK- r. A, JSilnau 

t 49cmd 




rifill vttttHdf h ^wMft^foltf J t^^ai ufem far wuratsfd aOitm fai onlvr 
to rfJkve the cifn^lMft of the knp. The blood u tbcit fbrcod ao 
Vktna^v into the pulmomry vUiy u to Iniouity ihc ahock of id vslrulur 
clooun and pfodnoe dn "McenCiMfmi t»y titf puitatmnry ircimd h>uthL" 
The hmgt may tkur bt flat^d Muitvk luv fiut Ihrtmgk tfu e^tOHtu^d 
rt£Mr gif a 4i fm «/ Uoad frrm ikr Jrvrtt and ikr imrtiasfd prtisttrv frrm 
th4 MvrddjJnf Hik9 vtrUruU hrhimd. A pcfaUttcici^ of ilic«< CDCulitiari) 
woM irad li> cauft & tmparary ttr p/nmattfM k^age Ihnmgh Ike 
Irin^fid «Bhv. «nrf fW r/rrlj 0/ frd^A fttsturt 4re lAen mamfrnkd in 

lOPM. Sttch A q^ id polhologit. niisila is luitunuu ujuu^^h ui pmllcc 
^^ ^ IMpugk ly no mfoHt iwtariaMf. <ind, 

mJiiii^ what markci kmi ^y^p* 
Umt icft^ asiw Inm tttn a aJif^l 
cbfnnic congniion of the bnJrt, 
Alomuhn tivcf. inlcaiJncA. kldncyi 
anrl long*, ana on R^fLjr undrr- 
^^^ ift^I ^ ff aUuid how euily ni luch cawi vd- 

^^H ^fcl^ J ^^"^ dttcaw ta a cu»e may be 

^*F.r8^ - N.,,.pj»«„r Th«C«u«liveF*cton- Ptm- 

r i*^!!^ I '"-rini^rwj finally All rttj* nWiilar murmim 

I ire due !<} alcnow ui abnunuat 

p*lifAi7 ol oee or more of the vaJvulur of^nini^ eiqcI these ondltions 
noiti frmn InAinmAlfoQ of the vi\\r% (mdontnlfiii). rhronit MitErosjit 
(utcno4cltroA>9>i (jr froiRi Kimdiimx of the v«}\-uUr rinj{ (relative Id 
nfidcncy), Thf nLi»tliv« <ondilIon* air fiillj rie^rritjrd, «v pp. S13, 
J14. Aod a atudy of the cauMlivc fa^-n ouLca dc&r the riiolojcy oT 
the ActOflJ loiotw. 

RnmiM.'OfgatikMuniitiriOccurriiij with Systole— (First 

ftouod |<^i>J uf itiitrituUf (untn(UOQ)v (aj mtlrat 't£vtfttijHi?ri. (b| 

iriaafid rtpafi/aliait it) ttntU timtivU, [d) ptdminmry iUmt^U (rmfe). 

Sjvfotic Diiuvna* w nno tones in Im iluc rilher to mltnvl rcini^i- 

tatjon or Mrtfir MRMVlti or, uv purely icciiVDlBl or ATijrmic 

UiirniiOTlIcAidliiDuvlole.— iSecond^ound- period of vcntric* 
iiltr nU3EBtior):-(a] dtviic fvpivp/ai«oq. ;t>J pttim<^ary r^gurgit' 
olktM {fWK (c) miir^ ilmojU {mtrly tmnOy dlnstnlic. usually prt^ 
syoiOiUc^ (d) trkugpSd dm^Ht (mrdyl. 

Punty diuHofir nuftsun a/e &lniuHl iavifiably due Lu oontc legui^ 

fnf J»plrl 



mcicAt ntAooutso. 




All tmpor^ 

Vvrmim Heard Trnmcdtatily B«for» bimI Rvnaing IntO' 
Fim Sound.— ifnesrftolic, aunttJ^-sj^irUt. Vcnod ot ai 
concm<t>on initiating iyvld«):— (t) mi»^ timwf. (b) iFkmfii 

A ptvtystalk miinvfiir u almost inirafUb^y due Co mftnil Mcooiii. 

npugSiottam f«tUv in atdtr. the muioing \moxm being ntc il« M 
£inn£nM^ to w w , lijubic mJtiol and 
ilouble loitk arc moct cnmmoD. 
■omc pladns the- Uitcr fini ^ fre- 
quency, vhidi isi^iesinit the iLLiUKir'A 
' prnnnil rrprrfmrf finil wotild irvj* 
KTCAtly ir difftTcnl dimo tctordini; 
(o ih^ prf4i:iniinanl ant »di1 age. 
ifflmf Oenosis h I'lrijuatllj over- 
loolwd anil 4]a:i mudiiiiptoacd in 
coanrc:I(in with Ai^ic npincSuikin 
where the MJljf pnBTslolic cv Tlmf 
mtfrrHHT ii fi^umlly encxiURtcnd. 

MitffMlwrtJy of tbecaflHprwnllQK mcu^iJ .nix. i.^o, l^v .Tii^fcm. av 

,«i»nlciymol1rniunnuranarrcrm '-"""«'^" "*<'«' 

(h« aoture of iho lesion, rriruipU- 
tion mLinr luunnybr it^ooclniifit viih 
it. Thuf all lUUatio k> far pn- 
BPnttd arc fallible tnd to anme ex< 
Icfil inl«!e*d[nj[. 

8flx and Ato^MlTnl rliMtie 
l^redominalca in wonim. aortic in 
men, In trhiidrrn, frmalra tre 
chiefly afFMfiH anrl in 93^^ of Haifa 9rrn Ifiv laion vu nu'InJ i^^r- 
sllAllonp ooilJc loLkajct bciDf cxinmelr rort- As ofee advinoes ftovtic 
lc«[oiu incniM in trfq^icacy, but the tnltml vdT« ttOI predomintlcr 

TIm DUTor^nUitl Points.— To liifTercniuce heart munnan the ful- 
bvring poJnU v* dcienunedt — (a) Timi m tkythm. (b) /'Wnf a\ 

flIffM, Ml-.' — Micrial anA vrnniu pulmtfrm, th« ndial puiae, bxreucd 
■rnof caidUc dii1ncs>eccculi^Lkin bf hcut auirdi. crinc«b. eikiM,«^ 

r««tlOA, f<Ani, tlll*4"» «b£ U «r lilt' 
Ifil *a]*t IV, TfMIMvJ «idr«. AV. 
Afuriir valrt. r t, ruibnbaFT yiIv 

l,V <^f[ imrrtflf It V, Hifbf *tii. 

V C t Vaik4 <t-i 1^' Vfc 

J'lilmdnirt v»in*- i' otr) 

t4 iha TfyhT hUR ttU ajc^toul litXi 
bir rrvfn nv* M— a*a Ihtfi «» 


mnuL ftEOiHBGtTAiioar. 



To DeMtmbM tb« Rhytbrn or Itin^,— This ■houM b« poa'tlw^ 
dcicrnUiicJ by uklns the apex lnai or raiotid patnc MiWt IcAii^riing bo 
the wuvuf. rA« r^jHi/ ^ttffd «jb«Jd ififf bt uit4. 

Hyp«rtrophyutdZ>lluatloit^— Figs 7>, ;$, 74ahowthcvHri!Uionir 
Quilia* in thcac coadhioas; thdr in^ucace upon bcait soundahubccD 

disnuBH and ih* pf culur dj^lerrociet 
In the a|«K bcjtUi- Simple by|ter1r>- 
phy n luuolLy uaodflted iri^h rhronic 
Eri^nTlllii ncphritta or ATtenti-oditftiaU 
4tid eimplc flilatau'on rcprtaeats the 
■fflgi^ol incfin>jitn8aTJor In luch ItuofUh 
QiT, Mtnt fonn of mTocordilu, 

ChMrKCi«riHti'( Svmptonu of lh« 
Sy»lolk VaUulftT Murmurs-* MI- 1 
—Sy^Sclit. QuaXiXy. —BhriAng, rf tW ' 
desn<C0 of inC<nAilr< occawjooUy mua 
ral, Maiimam Intetai^-— ^J ^pev hut a^^Uturt A<jrJ Mtyiil lhf[ 
kft i'lrru^ flifxrf rj ikt It/t KjprJj, TruumiuJoB. -TV <A<r kji 

J<rfWMii lb s/Mf dimf injrrvrr itnf^k. AnocUlvd Slpui,— rAr ^ffl-; 
■hmory tm^ni smttd h tkatply aee^niutikd; Uttrt ii hyp<rir\iphy cj 
liu fi^ htmU u>d la n \nsrt rie^n- of ihit left. 

vanL Cvihu: ffnliMtt I| falCTtftWd chtelly m the 

righit thv csnJiaic vci b^; vrtU Uiuwii iiL i)i? 

tooomfwyfag dnf^wB (6g. ^. i/ 'ftf irHm U 

fittty i&mpmiakd Ihtn on jar jympttmu asUe Jrtm 

tkt phyme^ ng^t; if iw<. the ftihe ii uituJl/ irrcgv- 

lar tnd of poor tcE«fnn, tyaactii is jimtrnt in a 

vafi^bk tad often otmnc dcpvc ihcrc h ptumt 

ptdmanary tmtg Mi ^n tr «t$aoJ CMtt4i4itim artr] 

marled rfji/tam 0rn<<H ivJAii^iiifj. Tbc iricuApId 

tm,j viM utd with i^J c} tie puimtmary Mter$»\iaSian Ihe t\^\s and 

wvnvbry effcfti nf righi heArt fidloR may eiuue . Tint edtma vtiHci 
I Midi tbc dcptcof canliK; we«kMH. fntfn dJicbl STvclling of tbc ankloi 

or b^ eo sncvvl inittm. A pati^iU it icIfUm so iU at Eft ht Uyand 
I jI^^ fo( ao rdttdar Icvoti Is moce naponsrc lo mticol tod ntiofial 
I tvntnmt Thb dM« «ol applj io ihcige <aM« of vuddcn rdutvc 
1 OTotmid ineonpcctlM fcith " CoaipgMjmoa m«S InjComyrtaatfco" 




akfufidmcy Atte co amle 4fl«talioa in vhich ilic p reyo Mt b ikot ijDod 
dmfa or chfmjt limUdfaB b^ut ■- '**"i"***» gmurl I'l^i ^ f^M of t|« 
Ab«r»(c of thfti pvbft] ocPpC flM teay ^T>«tiqpfcf patnlttcd by jp 
«nrfrmnHliaoranrtio-KleAatfi. AMitfarr ntrmiHy onf avonblf* tniin] 
Icaaon v titni vUdb aogwIuDcg occun u • tmaaftl crcnC » chnok 
intrntiiul nqihriik 
AORTIC SrEITOSES.-'I1a».--5ydMc, QwHtj.— t'mi^itfnA 

fcirti* anil 

Tiin . .. . _ 
HltH«W*a)ta(||Ktrfriikpii), li^^ilt 

'foa lk« |n> Jtf- 

II V. RltU -rtl-i4to^ V, C.?;, V»rt* 
p*»» vitfrfrvr. V.i. I, V*u ftti ,R- 

ra^tK<»ry Ar«<T, AO Ami' 

vtnatiu al at jp** ittbAc luir**! 

nijiTi{ r«-|irc><1iTi.^v'lJ -.i ^t hJ jrT 1ft br*^ 

I'll. ' .. I ' . '-4*4 


*n.[<^ l^■ Jilt icnlnr'r I- >li[| n*** 
rbin F).3l( lull vt Mo^l, l-M>IVt bf i|k 

A- "■Ik'- manbaf Hlhr VifVC 

V - 111, Tf^rtmoH **l*4. 

II ■ V'Hij, trilfi. r V riOmoMo 
vaTv*, l,A, t-#li tiir^t* k A. HuM 
tvfick- 1. V. L-fi «nitkl< RA\ 
Ki^M r*itrfifL«. V, i' > \ «iu rin 

r Vfi rmmnnvt TBVBS, I", <\ l^i^ 


TrMMilMlaii — ( YwHJ laiD fitrdJiJ mrJ sbtdn^ion. iMfeu m tvry 
ffikit MNmrvr. May, if tDMiae, be hctrd cTtf ihc vbole chat Aai&<- 

beat OMjkcdly di^Oftcsd downwAcd sad to tlv ktx, PaJk unudfr 

mcDSPm ftRGUBonAnoN. 





P|iOCftOeU>— U b a Icston of lon^ cJuciiiun. but b rw>r » oommon 

sclcroon of ihc oori ilstM. 

Difftrenliftl DiAgnoEtB.— lu trantrniEiion j]onc U drdui^ c»i« «i 

^kiMt-s art nifenUujifd u<^nd litviJ, 

TIOff> Tbno> .^>jJi>fiV-. QuAJily. 
- /i^YTrt'iv^- o"J/J usuaity sft^l Hui* 
mum Intenaity-— Oiv# W-ar l/rW ttf 
lUntm Ditd occittionalk chiefly to the 
righl of lt» liver half. TraDnoU- 

Ukr vhfjU rixJii hnm. and ttt Hma. if 
.^tt- iVrvu* poli^wt be r«ttmbfiii. itw Hk md«4l- 

bnum AtsocUted Sign*, -//y/«r- 
kvpky Of 4ihiaii^n vi tiihi htiitf. Diminlsh<tl \nnni\t'tfnm m tvit *>} 
pmimtm4ty i^and tmti. jUtitntini ^ ditttiiy puUafinf: jitguiar wim. 
In bwl niTi or an I}ie IcsJuii aitttntca. >1 m^ty. by ^Hifk |>TT?E(Tirt 
throui^ lite ffxttnl rcooua »yslcmH luil In olnrn>c chronk conitcs 
\\fm M the Irrer, i^err), itrmnich am] inl«stinet rdrmji nf ihr \tyvf^T 

tttiem. bvl mJiy be inrliu-'cd by heavy ilf^jnt. par- 
Ijcvbtflj U tbc luyuoiKUuxii Lc (Jiimtuily tliwaMd 
It is Mt UBCOmmon in heavy dnriking U«n)tf*n 
at liborm. ai^niaUy birwery irmployGt "Imr- 
drivcf's hcifi-" and indeed w ■n»w r^Mwiwft ifcti-f 
4a tuauHy lUifld- 

Progn<«U.— Poor if ihc iij?cn*e la prinitrr 
boi ft 6fua dittppf^n cnttfdy under ntfttnncvt ii 
the cnsufidtncy i» aaxmdaty aat\ reUtivc- 

Diff«t«a1i»l Dltgnoti*.— b often conlouDdcii wiih milnl rcF^ufuJ- 
uifns bil its danctcriflic bcatlua *nd waaaMou. Uir pulmnnary 
accood valid dlnlnalkii dndisj^ubb it trom erctyibm^ ei^e^i put- 
mpmiyiminilitn rrrfMlnhi mrr ufluaMjcnnfcmiul. Inian hiivinffitt 
nnuiTi'im a\ xYx second Wit bicrcoMtl nimLr, 

PULHOJVAKY STBSOSIS.— ^Vyrfi^'^ nurFnTfrj tH thf puim^tmry 
«noi «rr oAwtsf mvMfjr jtmttional. Tkt vrj^anU murmur ii rx^tmjArj 


i khiKiiun. 







f^fi and lanaSy i^mgrmiUi^ It pffaaM fa b mmnnfinlir ■rmcSitot wilh 
other cun|!mit»] (Irfocti. luch tt a pftt«ic hnmcn ovU^ or periofitt 
intermitriculAr bcptum. 11k dtfitrrmM diAf^nasii » ai ilaia ei< 

irrmvly rtiltiaJl, voocCiiiiv 

c^uitr itnpiinililr. Tbf typial 

QtijUiiy. ' tet^k. kMsh 
Mtn^HT. Tia«. - SyMU. 

TrftDftmiaftioiL. — May ht 

flf. ^. — t-uljllBfl»> 

ill AAull*. 

C-Nt ■»■>.< 

mum inntiwii. 

k€4td iftrr t:-A^ rffU k^atk ^ti^'^ ^Ut%\mmm 

■totf /ami fitJmmary «mi 

liu tprtt akJ inU> Ikt t^$U4 » . A«0C&a1«d ^A^%,—lhmimtked ful 
monary mjW iomtd, Uyptrinrphy of rigki hot't Cyaiwdi b rftii)i 
pTKlixcd by otniflh or ewrtitm und cuv be pcrmoncni. Il will cer 
tAlnly he fto If a patmi fnmmm nralp m^^riM vitk tlv pulnMSvy 
■tcAoeift It« viditnB uniaUy ^lic T<^nK of pdraotury lebcratloatt. 
ChArecif^rSstic Sjmpiotns of th« Diaffcolk VaItuIaf Munnan. 

— The iJia»toJic vaUular 

tnummn Afc. ih^ontLciiJIir. 

mitral »irnLH^«H nonk rr^ui- 

plAli»iit iricu«pi<l ^caMift 

An rairtplitm imat ht mad^ 
im IV Mtt «/ stm^rii of Ihr 

dluCoUc pemlhlv tTtrauw </aMiMflf of dh; 
lb* acm of blood frtim «und« to irantndc durmfc tre^i vhhJ. tfwv 
dlwioir h nnr ojflirit-ntJy fordbW 1o prodTin a icur- t^^^^N^n^t^^ 
'mur until juat btton aystofc. wbcn ihc vttilricuJflr 
luction U rtinfojtrd by fturicuUr contntction- For tbu retson the 
rhythJn of mitral or Irirutjild niuimur* <fiu li> tttsosb U prcjiT^tolic 
or aurictilwydotic— t-c. btgrnntn^ taU in lAr ^^o*l0fi< fwi^ JAtfy dnt 
, Jbrori ftid Arf^re, im^ rM/c dVuftSfy oL AW ^r^ Kvintf. 

MITRAL STEROSIS,- Quality. /i«fA vAroMy «f a to ttofeg 


Aorac wsov^mAocm, 


imrmfi^ m itOmsity m it nms inifr o skarpiy wtffstnotrd fwU twtmd. 
RiKiy (Joaiolic vmI Mill nii>n mmly divided. Point of Moxunaia 
Intcaittfi — i4f <v j4ur wttMn ihr b««L TraAJtrnioloo. — /,»nijfli u^ 
Uu mik^ arrm ant tmutty mry tharply tirfiftfj, As»ocl«ted Signs.-- 
Cjwam prtttni i« nowf Jr^r^ IkiI often BligtiE. ^I'^^nlud/A^ ^tm*m- 

try futad *ttd mdiroi fint nwtid^. 


< I .. Hii T^ ll«tfn«r<f lit 

<i imifvi nl ■u'li.'iil*' 

~« Burn rtipir: naH ^t^tnttt 

f»4fUf* *•-' ■' ' ^ I* 

<«*A tub' , L.. ^ , 

9 V I'lll- 

f A 

L B finjunitly aic(dii|jJi[iic^ bjr^ 
»ptc4ic mitml murmuT <regufpU' 
tion). Wiirtflrf hypertrophy aj nghs 
t^rtikklf. it, ptTcuKnion dulncn ex- 
Irnda M ^i)^ht cil nomuil bfrunJarif* 
Pulse. Smoli. rafiii. iniiolil* and 
iftrgulitr. Thriii tisnaily p^ftnl, 
fdi itcit at or ncflr point of nuui' 
mum iniriudty of murmur. \ (li*K- 
r\ai% may oftcr* be made by jialpa- 
tivn, d prtsyiidu: ihriil i« 'j^r milraj 
arra bring fttthfigiaitmflHif it} mitwai ' 
Avwjvj. SecDQcl :Hiuncl ftrqiiDilly I 
douUcd, I 

8ottn7C3& of Error. TKr- dliK- 
loUc munnar oJ miiml slcnu^s mtj 
bt ccrrfcMjnde>(l wirh a r&n* fonn of 
aortic rv^urgiLuil raurmut that ui 
<littinctJy hcord ai ihc nf«. 1 he 
jirct^^nlic murmur k fijtpimriiiblr Aniiudv 
or inttfTuilEFTiL RiAy bir licard only 
tn rUhor iFtr lUruirn^ or iht tvcum- Mttho- 
Ixjil pOMtiud, and may br- fntircly pfruuc. 
oblilfnTfrt by jirtnting loo hm^ily 
»tth fbi: IkII ijf the !»lt<lio».opc. 
The sharp fiafpiȣ first jt)htid it AIit.j*i 
tmntity f«« (jriitn^Jy chutttritrutU munvv 


tkmnii rvtn ichat «« Mnntiir li pnami 

IC REGURGlTATlOn. Ouality.-^ ^^•^4' »im'«^ i'/ 

ptuh amd iMmvity, ursj/iy rnoMvbttf /VifJfvif^, ocutifmuUy^try . 
lAtfrf. ptrhapf mtuicat. mhkA wtay rfriirrlj or parity upJate ot hH j 
ikgksiymu^fyiktutat^iftimd. Tim^.-DMhUt. (Ommondnf^vtih 
or fadftoiiauly hSkndag tbc xtond tnui^fl.) Hudnvm lauiiiltj. — 

Jf 9*n«carM (Mcond Tight intcnp«or}. third tejl inkripC44. fr oi tfllt- 



II ■oawv- 

/rirw. 1i U inrrraivfl by nlsln^ thr ^nns to a vvftfnl poiMoa and bv 
turlkiri aiid Krj nnl) thift miKTniixiabcaH«nlratll>CBpcs. Tnii^ 
SiinioiL— Alo«ig linn ihown in fig. loi. L«m Irovt «cu<«tf p>^ «idcr- 

frequently >Ai/'/<iJj^-iijmJ«H'^Cdr<ifUi. A»o<ifltri S5gn». — PaiUe, 


rs* ?*s< 

$/nmd dMntufjM dr ^ti kt ccfttHdt: vmciiincB a pKuilo-aiiltal 

$Unmh (FlinO miimiut CafUhry fiaStf-^U Ibr ouk be amninni 

closely, [f a gLm »lidc be pna$t^ urun lie Upi^ oi if ibr ikin 

he reddened 1>y Erktioiw h rbylhmic t^uih may be wen- BadiAJ 

PuIm. ;1 jrrking. throbbing, slappinn f'ulif ([hi.> "Corrignn" or 

"warfr-hummcr" |»ul»el whJd) tntj be f*it in 

shaking hnnM of ir ^^^[^nK '^'' ^'f^ "' Th» 

lit£ea or Icxa. In onkr btsl lo apprrdat^ the 

lack of ffuiiaincd lenrion il U well Xo n'ltt the 

arm And Ku>ip the wruil Aviih llkc h^nd In >uih 

a way ihol the ball of the exatniner'a thuirib 

ovfrlfra lh« radial ancry. llic fmyirer ami rhumb 

meeting on the bftch of th» hand. Cardiac 

ArMt-"Thc^ cardiac arra ii iTicrauM downward 

anil 1u the left because oE tefi venEriculoi hyper' 

tnphy- Pta^ASkiM irtnarf HI jtmfitair. This cuncii* iharp thodklikf 

sounit luaf be hranl fn (he fFmotnl aiicrii^ m markrd nues. thtsi- 

mat. fhtinimxw ptlfH^utn. tanli^t ^m. amd tmfcithfttic tympivm* are 

ramm^n m Ikii Iomh Tlv oiiHrbahnLTsropr nay thout fffMaf 

urArri/i^ The second nortic >ouad i» mafkcdly dimmiihcd and 

III L.H A*-iii. B<- 

f ll'tft'JfKtl. • • • oav' 
I mn » mi*a«ii]' 4i^«tii*n 
ol UBikWHtaiL 

nmiSPTD »Glt>GITptT10K. 


In CAfoUdih Afr$k rttufciltiu'n ij }rt^»m£y lurtrthiW aith ofrfic 


SpbtvziF.t -- 
1% ■■itl*. ^-'«- . 
TW tfyM^l ti.. , 
rlw Bnrl* »«! i ji 

■J SyiBptUcnb «i»l CuinuicaL— Ab id olhrr ktuunv, ua 

Eoaittid flobiecihY r.'mpi<:cu may be pment whi'L* ^m^^nulioa is ni^n 

udned hot. mfirr: cAifo. thnn b llirm, n djll pain rir vrnc of opprcaUm 

JD iW cudbc uta or aharpcr ncunlgic [jtunjk rcffrTed lo the nc<k. 

^^^^^^^ ahf>ul(4rr, and ««ped3ilty ihe Id! 

S^^H|^^| »hcjulctcT Bud axTDp or t^tit true 
k^^^^^lB juigini p«i(.'Iori«, may bo nr>Ir'1, i 
In ExHzcmi^it jLnd pliy^itaj etcriuni | 
^^t mav initiate or provukc rccarrcncie , 
h^^a|^H of thav sym\nnrr\%. Vcnlgin, iJnni' . 
^^^*^jB >iTiciijif. Aul>jccti\'r or true dyi- , 
ta^AL ^ |inim, inrt {jalfnlativn may U | 
BHJH^™ jtrcimt. The patient U usually 
B^fl^^^B [^1-r^'OLK hi|^ sfrunR, Sital. If h<- 
lUJym^^B !kml <?iKily ilqirrvu-d. Thr mrru«l 
U ^ ^ , 3UIC Ja oflcn cbal cf n^ynuihrJiin 

;'Bt Ihii- and in rare inskuicn a<lual meUn- 

I'.-nm (ihulJu h a\nci\t6- S\a^ u often 

„'t,k duiurbed hy drrafot or an lciuaI 

a:5i'l!KSSfM7';£;''£li'/"^ ""^J ^-r i^^ a»jt^=>uaiik w*t;n« 

^fkr*pcmiHin£vtlvf, A^'t^/A.-A *]if- vrbidi ibcsc r-oticAla oftcn com- 

^^^■H fliiniir ^aUlHf] ifrC ttpcTiTD. 

^^^E«ndir«vn<i«.«iUpp>ni, Icm-Mn plain. In the hUrc ot tncompcD' 
I cvpTtf *»iv*. 4 V, .^Qftc **(». f% iJiiKin thcw ii lit:lc^ U-mlcnty tn 

v;;t;<,r-lip?it^' vrrt;«';*.r. ""«**^ mn^mHon unl«>. » fir. 
lNln^i!r-^.^7a aX' '■ *^ ^"^'^^ happtrn*. thcr< b a ct^<it- 

liteiU or secoadtry mjtnl tesion. 
Etkna of ll>c Aiil:k9 £■ comiuijfi. hvwcvrr. And liy^pn(rA, |)Al|>ilA(£oik. 
oppmuoo^ rtc- tdt iho talv of ordbc kvc-ahnoK, 

TRICUSPtD SmOSSS.—Karr u^uiMy -"Ttermttii. Qualltyiod | 
Tte*. — Ex4tMjIik0mikmi tien4^ul. Point of Mftkimumialeojity. — | 

Hthi ttOTtat hmdtf^ Associated SIcoh^ — Marked oAnou^. Di&ixtv 



Ulc ut ab- 




Tit. i^—/ivttie lt<«af#ii* 



PULMONARY REGUR0nATIOV.-A«n. ium^ cmfowAir. 
QUAlJCy Aod Tim*.— £xMJly iHt nxroiir «/ ofrti^ fettt^tUaiim. 
Point of ttaximum IateEiutj,^5^n«<iJ jr/i imttrtp^a. TruuEnri^ 
saoo.— Omt jlcnuM* «nJ itr^tm iU tf/1 

U^ioa bf tbc pcroaskiQ srttt, whadi b 
Uifti of ft hypcTtfOfiJued ngM nnthde, 
and tj die dijOciiifaJ signs. TtK^r w 
cTvmott tad owriMfiuion of Jagukn, 
/ft aWi ioi'flt M^ vrrjqwl Atrlif nrmtf u 
ctearij hfiar4^ NUricd |erkf pubatioo of 
ivn'phcrnl Rrlain, the '*Camgkt% pube," 

Rarer Murmun. At a taatltr of tui. 
putmiHUiry manaturi 4nJ llul 

CJbif M^ Jta» ptaOkaBy At r«nsu|fT miI^ 

iinii milrni jini ttWWc itov^Mj, Ai prr- 
li^'Uttly alAltxI a iyiSvlii mmrmi^ b ilsr. 
ain« timM out of loi. l*> mitraJ rrj^rfcilfttian or aoflic «*CDQm wd 
4di one b hpard heat at Iht^ ajia and uananiitlnt id the aiiSb and 
bMkp iod ihe other is beat bcftrd at the aortic caftilij»e aikd tranvnined 
apwird, no confutlon ike*d occur TMt pttrrly M^sMk mwrmtMt b atoMCl 
ccrtiuEL}) <iui-' to iLonii ^r;^vjpvitat>"(i ■'!<) il» peculiar UaJUiDiniua and 
xht acoodalAl ngiu mukr il <)vitc uniuis- 
ubbk. Tkt chit} wsrix 0/ ^rrnr im m a 
faiUtr^ h i6kr tJu iimf 0} ^^y murmur ly 
cAr titrfUd bii\U, rincfully nnic iu mjivimnm 
intnuily and ttaii»mitttoo acdn 10 ttc < 
of two iBunfiun likt in rhjrthivv ifaf j. :^ 
Add quality, 

AMOGuted Hiirmim.— Any oambin&' 
lion of pijfmum nmy be pomunipml ihough 
b noH iniU9c«* a post mortcB) Brcftdy n 
duc«« ib# tKcwivt niunbcrof ptMumpdw 
keuuft BcnncliiiHv irfnrtrd 

COHGEKITAt HBART DISEASE (morbu* wmalwu.).— The 
'^hitk vJnJm*' h noL nJunp blue, fur colftin JcftcUauchasthoK vf the 
auricuUr fcptunmAynitlwiitoui cyanosis- Oa tl»olbcrhandab«by 



may in fTrfrrinMl cwcs bf ilcfkledLy blue tvUli m rvirlerm of bmrt 
d»nM.winMCiael»o«iQ Iodic aulhor in wbich nlafEcmrusof aJcncad 
tiuu^ in the «i«M ^ubjirTHJi: wu iccounublc tar ihc cx^ndition which disap- 
|jcucd ftl oacc aJkf ofjcntkio, TJjc ruk liiiliU Inmrvci lh*\ an tKtive ' 
»fli/iMt #r MfMMtf «JUU lAdf Ji «rJrr«irfy tytmoUt ia the V'iami nil 
mn^ec^JIfe) tmit dbraft anil in rrin^ inalaru-f^ EfW. lutrH^i.c-firri rtmiKul ' 
mntrmtirt aic heard, oftcs without ihr Ifarilla or chELra<lcTul[<: cfianf^A 
fai cardttc outlmc pnt^ning To thr ordiiuij hcirt Inicnx which thfj 
en«7 littiddCe. CIiibbiEij[ o( tbc linjccn imd tot:* &nd dyapncrA fit-' 

Tlie ll^lun^ »^fdr friiiii \\\tnK tflmdr (Liftciuaci] iniy l>c ltiu» cpilo 
BUtod:— AwtcuUr stplutn d«l*cU — no definite symfiiomx, V*atriC' 
lllar dviocta— simuklF mkral tr^rgiuttoii but lack synijiLotHH of 
pidawA&ry fliKorj^rmcrrt- Not id he posftiVch diaffTiosed. 

Fmiil«iit Ihictiu ArterioBOB.— roit tyitolic murmur emiinmHg 
htytnd lAtf atumd ismnd t&d innwniUf^ ri^lthtlif into canititbi; rsdlAl 
pubc snftlkr in <kcp inipim^n- Ancurftnnil dibwion of the dad 

IfWjproducr pan]y?(i3 nf tiKol conla ll]niU):]i trctirmithi^n^-ral n<rrv«. 
Thtn mnybQlMcsysUJictbnUtdppiurft and cyonoais Olid slight 3«coDd 
pudmoAtiry aL-cmiiuitlact. 

Pernctcai Aortic tslKmu. Arleric? and piilM i>f ufix' cxirtmiiy 
(brmrhcK Imie '.he an h» ^tf brnjp, ThA*« of the- Uwrt-T rtiwmiiy *nd 
Inmi; loulli ibc pulv bdoi: tnarkciU^ delayed. Thir ItEl yvnlndr is 
b|fVtiupliM and Ui«rc ntv visible cotb1«nLl inrnal coniTnunfcaiiona 
(e^ iBteniil munmaiT — iu[l anil vat. qii^iutnc. flon^alLi ua|>uluT xnd 
' poilciMT MfeietCQAukH etc.) which mny yitld tysi'irEk murmum ind ihnllL 

ConiBieitt.— ITntortiiniitrTy ihrv Er.^'nnv fLuf1ir|pi\tty s-Af\\f Jtnd JTidc' 
Unnlaftk £n thrmsclrca nrr uiualiy <ntiihmrd hml seldom T>^rmit ft 
^■•dflc lof^fiiing dia^ocii 7*/- mbmmpi ujv b^oUc or pN^it vyRtolic 
wrv bl polmocurx trgurgSuXion and irt u^u^j boilrsi o-t the haK- 
P'mlm^m4ry kmmt) c*u*c a nuricd pnlflrRpmtnt nf the rij^br heart 
■01I A miking dboimiliDn rrf Ihr pulimn^ry vmnd Knunfl vitti markrd 
tbriO ia McBcflfa. l^cnfrwuiv uphtm defnt mn^ Ude both thrill and 
hyprrtrophY. F^itnt daans /trUri&sus may «hotr maricfd ihrlll and 
00 hypgTipphy, >< ptrsiihmt a«rliV m/Amim i» plainly mdjcald, 

OCMr COOfiftlttl AiKiVAUt*-— llff bfflit or tht grral vcvcb mSf 
be tna^ond, cdmIii od ai& iwo, or ihrrc chantim. ihrouffa com* 
plete aefittl defecta. or. tfve heart may bt placed in the ntck. ahdornvn. 
or. wIcIkhM itir nhtxt i-4i]|y 


L ti»l ;iv 








mtnt t» tbiduldy nxntul. •nd a lndt of it lu^ to slos of coootMon 

no lew than oenlnkA. Owinf lo lh» wondnful intcnfifon of iIm 

Idling mfduui>ui» oniUqUJjis ihc IjIouJ vcbcU 9mA Utr bcmrt 

«fnj f<vnn of fccort dvCect maf be to comrpcculed for wymg 

; u to cquBliic 1^ dmikikw And minlinlAe snmpUKiuL A flfnliJM 

ftcejEDJ^a Ihrcc diidnct pkaxa in the coant cf «ar boul lolon: (i) 

ptrj/tt €fimpemia§itm. («) impaired comfMUti^ii. (j) 4mC cmt^MUtfAfM. 

\h rr^nb the t^nr chief VTirjcliTa uf vaJvulai Icsiani, nuadjr, mitnl 

regui0t«tton and tbtnom, ud Aortic rfgurgiUliaa uiil il«io«u, Mhf 

I fini xi9£4 timf ihaw tmiliing man ihtat die pcculur munnun. ibe 

flijumctietutic chan]{c in ihe cardrnc nulJine. vU<h M^cd ntky be 

4Hght ffir > Inn^ fipnofl, *nd rrrlstn rharnrtcT^fctifs In rfinnmlcm wlih 

I \hc paim or jgcnvraJ r^edplci^ <ircnlotioii, Thu»UttaacDl le oqiuHy 

' inn ol OKt^ forme of niyoorlitia ^'tih intvnnillcnt r Jblrtw Mfn^ 

' Inr inaufficicEcy tm4 indeed ftppUea lo a grcAtcr <ir kncxtcfit toill 

Intone, Siu of conmunioD occui in connecciaa viU) tliii MMt Bud 

QinftUt of mnldleKimr Itttahrrntr. in lit wav oi irrAimenl and tbc 

creation of unnecctnry darm ibruujch Irrulionfil and teniffing 

,eDnii« a« l^ prognoni. Surh Hf^rl\ nr^d iUlU o$ mo JtraaMHR 

I db rtfrd vGkhinf, from Ufiu to iiW^ 

, (a), Inip«ir«d CoTnp«ns«tioii> 'fhU (Uac i« the one mod 

jcnanly cDcoui^lcred AaA ihr »riv i^^imnifticil !n cnnocafoa wJib H afc 

cl)l«0j ibotc of ominiim due b> a failurr lo nt^ffiitt and tnterpRt 

I oktcure manlfnuiloiu of the <mtlili;Hi. Tn ma^jr tt^inns ib«sr ^nnp' 

I toma on Aciudljr obtniaiTG; (or example, the rkiica of OMiK nfMrji- 

' idiioH oomplairv of dull pain aod oppreciioo in the prvcordinna or 

'sharper neuralicic pafn» radiating Uj thr ncik, left sbaulikr and tiu^ri 

ihtt Ml arm,oT. h« baataneiub)cctiv«i>rob)<cd*t(4VfKia^all«^ol 

fr&touncfA angina [«ciuri^ vrftfgix bndache, Umcnnk. probabtf u 

I Eureftsc of Uw nervoui irritabililr so common m those ?ttac», or, «igM 

' ol v^conHu}' mitral Uutmt nay appeu^ In mt/mf tfaudt the dyxpnisa 

! may be uurkr^ln e^pccJally tm exertion, the pubc l>ccoanca rapid, mofe 

mariedJy irTV|£ubr ind upr<|tia]. puTmon&ry K^mftrtitvnx and tilood 

. Mmkcif fc|.iulum m«> bv eviileni mid lliia tiity even l>e ird;xliAi ii) 

iISm don^itkm of the kidney, r^cmecJi, iivcr asd aplaen. In fnibvi 

' regmrgiMiov much Uv aame ^npuiina are cvidnit and if Ihe n'ghl 

'hout b markedly wcnhened or triatsfiui rei^uriiSathn 'wk eslablis^d. 

'ttiere k marked diminuiioo iA the piiluTirary awiind BMinri, dfrwf 

, puliation of the extended jucvUc^. pulmoiuiy <xingcsUo&. odAise 



I of iW tpl w n >nd tiYCTp ]D4%mioD. flatukncc uid fn cAiort 
gearnl^ viwvnJ, pasdrE rongniJoD. Ttt€^f sympUmu orr J*';?!- 

jMfaWtfiffi #/ « HuAmei^ At^t imfaist jtif t/i^t cj kyptrtrophy. and 

itti&mj nkran it \%;^ to Im a1>amt or «]])^] so lon|» hs ihf mitml 
boldi last. In nMflnj/ tlrsifvu cilfmn of the lo^rcr fMrtmilin MJy hn 
prnri^t ivitfa ^rm liight ikr^^rfn of fncompmuiion 1r Ui» Imrr 
iCft|pc» EounJ lauartn oiav appeal. Tk<se are pitjiH straiihi^ 
jtnMfd symplafiii. taik irt'A ttt dftir mtaaiag, Mif iJ ir tpiik aihtnriff 
uihcn Vfw dbd/j vritk Ifcc tirfblcr jWmj v/ tnth iniompcnutiiifn ami atill 
■!> in rrtilioa lo Ibc dilAtalioa luid Uighl mcoTopvusatioD aiaod- 
with tArmmf my^fCdrrffJir; cihs which frt-fjueirily jinunt no 
Miurnuir until ral ind canfijic ^cimtilcinu hove rmcwcd the toniu of 
fhe hf^n muwlp >nf1 nsimwwl ihr valfitUr rinjt- 

The nerroiu systcTO is pci^ilEaHj^ alT(i^c<l in niuny i:M»f:» at «li|[;ht 
inODmpcnalka; , ^Vrrtf i?; tAr mt^st iypiiAi iases oj tvur'isihtnin nrriffn 
hy Mm aalhof hair btm asifiint/ii ztHih -l rilrwH iTT aimost aicnf k\lt>tSf 
0r aifm^Hr 9} Ike niMs/ tsihf. and indeed s^-efiti ttvrf iun>tiaied with 
ud ntviit anmrism. Knihfng Ut commcirurr In thtv oura 
Mf^vw irnlal^iltij. ilnf^^liiCTd or insoninu, Uck of cunccniia- 
aad abihty 10 pttiorm BiuUiiwf] incnTal or pht-tim! v^irk, vhi\i* 
ondtiagliDSof tbecxlrrmLliajuefrtqucut- A^irianfi^tgnin 
ibcM CUM haw boTQ uwdalcd niiB only sSiKbi incrcuc of ihc cortUjtc 
irr*. vTtfcrbInt of wmMTlur lirtjil hcnn «Hind*, anc! most oficn, 
marMfy dimimahtd tir d^jm/ itllJ^^f firat it>vn-J, Tbc RkiamAy lirLhc 
M41 ol prnbimi fmiriim or tt»ema nvl vtry ofii'n » vi^ry 4li^hi gniilf 
of cibns iBAj be pTCMmL Limited uwuLj lo the tonrr ciucJuIticB. 
biltl«nl. u)il ollen moM marked oirer th<* of th« tibia. 

Tlie Li)QC'-^^^^^i^**cQl dry cough, vlifeht or tvtn marked cmi' 
0Mb>a 0^ the hues. uNbfnatic ncuniicL diffuse bronchitis* modcroif? 
gnAt% ai nnp^yvmA nnd jvnUtfnf phjiryn^iU md Urynjcttb^ mity 
divert allcnikin from &n underlyin]^ incompenBHtinn, which b either, 
<w0>lfTe. or a Cactcv in ibt tevtrity vod coniinuum of pulnonary I 
9i^iii|i1ucai- I 

XlioGRttro-uitcftuuITntcL— Indi^tiion ond penistcat o^nii^^ 
ibm icyihcf wllh rnurrcni aitadu of kuic i^ric and hci^iic db- 
turiwDCB uhI hunurrikoida arc frciquonily BMJCiAtod Vftih incSicitfit 
h«ar1 nctiOA- Thr auihor firmly bfUevn that tqul^ tA ^, mK&u 



nmcAi nucvons. 

■ne*>fn prr- 

obt&incd by the nai cut ia ocurMthenit hulv be AiiribiJlod lo tk 
good HTrfi upon iberlM««fJkaM^%car'«4lA/Jk«'«WJiQjt i'iH/Ht«iaHvfiii 
milnJiiin. Ccrujnly un^ mmUl ioA iJijaital rrat «il of tbc rjmp- 
flomA deKribcd prumpU)? disappt«r in «I1 mioor dc^cncs o' woftanpa- 

C5}. Complete tncompcnudocL. Tku krm th^tdd b^ o^P^if^ 
to Uuiif casrt in MrUUA Ikr k^^rt mtxuif ku atmfi/tfiy iotl iit nv^/jfr*- 
A'lYfbo/tJy ubftcn bLbclcrmjnAlHA^of 4I] c^utAiclKarl MfiectficKB 
\\nt tt^nuinate gndirLLly, or by vu'J^m Ihooigh oot imniMlifttelj frty 
rui>tm7 of ^umpcjiulkii]. The bat exa;npla ore wtca In leisibil 
cue* of cfifcnivry Klero««> fntly Jicart nrd chroi^ic myonniUl* IP 
gcnrrnl. So ab» in miml Ic&tnnA thrrr a>Eiu-« a r^r whm tfir hmn 
thai bu tltMc or with iUiBula;icc afram ind afi"^ rrcovcml itacU SnaHy 
yieli.lft ind t&kt$ all lhera|ieuii( nii*wurH. fn iixh trrmiiiAl «m9 
irrearvaaU^' cues ibe oi' 

ihopn^ic pa<icnt<iftcnfaUi 
[be bead aicEilcttly tn>m rfdc 
to Mb ood W4«r« « ptcu- 
Ibriy Hfllen yv^r disareisnl 
And bopclcu cjipresvEon^ 
The torm i» (TT<)utnily er- 
rontotuly applinl lo iijf^ 
of vcfy mvkod a^d eMrcnu- 
cardlK wcaktimaml rijir' 
cidly lo that of milml rr 
gpMgElBlkin or (lienoKL> u»- 
dtlcd wlib ic«cini3Arr UV' 
, cuaptd leakage and ^eral 
ADUftKB. /ii milral rt^Hr- 

_^.. , ^ ■ I ^ tfiiurtiilt jbiLpttd, 1lri4nirum imirvrvMm 

nMptifflid/ltTmtiialinnJm- .uLWTft<iil<afA>H<iu)M« 

Of a ffimofy afsum^Hn. ^ !**■« it m cxrdiAt Unan in leAw-j^ ^'^'^ 
frffilmrHf (4in dif ifr mucJb, ihtfVtTvy uArrn« may Ac rfh^ fnum'/'J'diibiiu, 
jfidtfird in thf! cuie itil all heart ItrtiimH Lt t« only after trying and (all' 
iiiK lliai aumiiiifr b JLUkiiGable on the put of ibt i^yaidan. 

RdatiT« Innifficicncieft,— The secondary dOMiation of the votniUr 
ringt, lurh HI omin in the tricti^d Hlnvdng pralongrd mitnl Imml 
or BS a Tcault of CAyocardJlia and severe physical xErjun, or in ibe mitral 
u Meoniluy ta aoitie lArioBs. cliranic rayocudlib or i}» icnulnai 

ULAT1VK IHilliiinr<l IfH 

of aa ml«f*?rtUI nephritit lire pngnons tt ranabl& In nich cams 
UTtiirr (iniptT trcaimcnt the irioo^nd LikiJsEly mrtii<Tii i(i fuiirtion in 
vrhole ur Ja pftrt, na docs tlt« mitral lo & k» <tcptr ui<l wiih Icaftcon- 

E><Mt.u«« «f Or* ^ttU. cam 

Tir Uft hntrl <«K5 a5*«iafrJ vnAb ntddm fupk^rt c4 com- ^uJ'icb 






ckn(7 u nftai mtounirird \tt rtironic taicniEllB) ncpbrilii wfll nofl 
respond to treatmccl wilh tnythjn^ Ultc Ih« promplneu xisually Doled 
in coniiMtfcn with this vjjvulnr lesion, and. nnormvrr. the paticnU M 
ibis type ut often irntAblc nt!St1c»H HifTiciolt to control vid qtdit 
Lintlke tli« c>Min!krJly pblcfimntic^ chM-rful nlinl-nguifjitafit |«d«Al. 
THORACIC ANEUR1SH.-J Iruc ^nntmm r€fracftti a hc^ 

Btlolog]Pft— Anj facion th*t lead (n iTlerud cIcjEcncntLon on ibe oee 
hind tnd AbnonnAlly kttat vatniUr iiMifiSnn upcm rhr rtikcr mity produce 
UkCOricRli A$ b uflni MjJ. tbc vktiJii u uftUAlly one wIhi tiab irot< 
»hipp«d at thv Uit^n* ol V«nu^ Bbccbtu or Vblcann and lio ttiMt th« 
ELUiUcjr vr4>u)d add Migrnmixi il nui MincrvK. Syphilit ttuiHts1itm«Hj 
tiatuk fint as a t^ntt and it fetp^mnbU for a iar^ najtiHiy of tkff Mta^ 
tnt^mpffonft v\ ciiinjf ^r drinlcinff. pHyMtAl and mmiif flivn»**rtt m 
tn'erstritin rtci 41 o-jniriljuiiiii- i'*um-*. the fir« tffmpiuta in rotnr u«> 
doling itx-aw siitytU-n, tnvtrt or probr^ mxi^cuUr Hlon. StvcT»l 
uuca uujiiiiiy uittli^r ibe authur'i utuvrvaiian have daied tb»r •^mptoais 

, from Mvere follA or mihriy afddcnr. Il ut quilc pOHiblc Ibat a oni' 
fCcnlm] weakcLDnnf rhrrrfivlt Ic !i fnrlor tn ihr nnpurfumx nf the ynunn 

' but in aU iLcm ^aks It U JifTicult to 1>c1jot ihii wc c«n exclude a 
pnmwy InrKriii"*! (Icj^wwritivp prv<rM dut to one of the futon ortp- 
ludly mcntioticd. Thr dUt-tut m nitick mon CTmmm the* i» gtntraHj 

' tupfottSoHi u frr^umUy ike ota$t pf suddfit 4*cth ftjrfred (irttfcMir 
ilidopiy) f£ otkn conditumi 

DiffictOticaEncouiitcredinDuiKnosift. The tistcoribcfluorompe 
Ami thr \-K,Ly [iho^i^rLjth h!t\ Miti1i.-[t niTTally tit our dbgnofitk motirrf« 
nnd made U ptJmrblc to rctogniix oiwurbm in lis farflei stages Ortrr- 
*pfrr na 4U4ast U mart Mtity rt€i>s^u4 in tht frtsmt^ oj its rldmc«J 
tymptvms. nor mort frafuenlly nYrltw/ial whrn iftfit art ahitni. Tbc 
old cbnicaJ divtfiom nrc ia), Amurijm 'j.-tih tigni and tymf$am^. (b). 
AivurUiH irSfk kympkmt-y t/iiS na T^gtU. (cj. ABmritm v.'iik nrilAft 
tym^mj nor tifm^ It fthouM be remcmberrd thai (a), ClaMical symp- 
toms develop only in ccrtam <wt and then usimlly vh«n the TcnntnaJ 
atagr U rcacbcd. fh). Th^t Wfc anciuinu mMj cadsl Fiihout them, 
(<), That death from ancunhm it frequently tuuui^vMted both ante and 

' pcol moncm in ihr ahMTia* ■>' »d autufvy. (d). Thai orjimtry Hm^' 
mnfk retaurftt arc thcfefon unAatufactofy and incSkirnt and (t). 
ThaS Uu fim^ffsw^ pirimrt trr X-fCay pfmlflgraph ojim usuaSyikftmlj 

■ mtans ^f toHy diagnosis 0/ iMir tamjmmd. 



8t«tuitic« of Aatrufism-— Roughl)r spcikiiift ihrcc-louillu of «jl 
actnrten »it aortir. jw<l ninrlerti -twvrtitths of th*^te btt fountl in the 
Lbormcifi «orl«; of tlioc go'j/. jut auiccuUr; from So-90% «ccur in die 
vttlr and 50^0 occur between tht agc« of 35 and 50. Tho people 
whooe b*liii3 11X41 TujierLy irprctcni LilcmpuiacE ki food uiJ ddoi 
oad ocnipaiions vhjch involrv tho nuidmuin of blcntpersnct uad Ua- 
bfliQ to lyphililic mfiKtion funtifth ihr chirf nminfilm to &K irridenrr 
ftod moTUliiy of the d^coK^ 

FttTorite Sitc*,"The nvrt td the aoiu, iht junrtion of ii wtfvnd- 
Ai]C &ad Lniiiairrv^ purti(in\ «nd ibc dcKcndin^ ikrch rttnT«rni the 
chkf potru ol iilaolt m 'Ikt 1rK{Uc-nci< LndJcAlrd by Ihcir ord^rr, 

TenDtliatiOJa-— Tht ptujiai situatiuu uf lliesc timmn wilh a rtf- 
«rcncc to ftdjaco&l and relaMnnidumroatlily cxplnin^ their ^pap- 
eoeuiviiogy Mid irrmiTjiiion. Dfait ouuri sivtdeniy tn almost *wfy 
JAjijinv heia$is< ttj ruplttrt 0/ ^ vK. The blood may fiftu intol^ic 
pttinutlturrk or acljp^cni pulmon&i^ anr<y, info iht tii[>frii)r vf pa c»v«. 
tbc csDphacuA. a/ty oiie oJ die four bcftft i:h&inbcrvH the lutig iladf. 
1W Bbcdiulinttai. or, cit«niaJJ/, in nnmnsmM eaiinng pTMcure neavufji. 
As f^afds nhiive ^ttqvncy tkt prmarMiiwm. putmimary artery, aiid 

fl y n p ttim*,— A pnlaiiing gruAmliy mlsiKlnj^lumnrvliMn n ItmiTH 
i^itfX tXM vrjih uBporUni ai:i&loni^iA]il7UCtyrvMiic«riAA pr«doDiiniUic.e 
of fr^mrt tymfUtiUy nfiicbtDay 1m labulited m folluwt- — Esofkagus. 
dT^phttgia. Tiockc*: — bciMS cough fganckr col^)* dyspncFL itridoi, 
brsadioRlMtft *nd hemopljnu (if noE from ur itself). Koof 0} 0u 
ttrng. tfwf Jte pfMVV.*— .^jM/fMU inggnjine phlhhU. piilmoni^ry oil- 
bpsr, pleuriff, etc ^<rironffMiii.< PcricardZtfft Cfr»i u^/f; LoctX- 
i*«J, ihill pftin. /Vffwr ftrjidiii;— XfiimljEirpain^f^rcitjrkniilflndbwr- 
nultcnL iWomwKV? Ar(o7> A^ntoLc j^ulmonftry mumiiir. iHUtrd tfght 
bttrt. Symfttkt^ ;atfvj>-Dil4t«d or cootnctrfJ pupfln uniUt^rd 
wctlbg or pftUor. Card£>^ ^fccriu. nAginjil atlAckv S^tptn(^ ivuo 
<4M>- TjSxmti of upper exlremny, cvuioaIBv Th^tatU due: — Muiui- 
nnia. VApv:— DyKprp^a. naiiwa. vonnliln^ ilyxpnir^. hjoow^, 
Pknmti — Umbl«ral -iLaphrapn pftnlysiK Ree^ftat: hryngMl:^ 
KeVMfMA. ■phonn, cpAim or panlpis liffr cdM, ptnorviiRii dyipnati. 
it auuf nef (0 foffoikn Uial ttny or <iU 0/ lArjd ^^^/e^oj ni<j^ ^ f»uirj/ 
ky wtfJJgjfti>af growths oOur \Kc% imtwitms^ 
' FHT8ICAL SI6EV8 OF A1TG0RI8U,— Idtpection.—Thk must 
be bolh iljvct «nil intij^ttial «iid one ftwJES primfihly lo diKC\cr 
J<v«f Mip<^| or puluikm. The ngfon of Ihc miaubrnim tt^ ^^ 



itHiai pre «- 

Mar iHt sb- 



If ty|ikfi1. heaving and expanrflF. (b). Harrly^a visiMeium^yifUmg 
exfamiU ptdtatm and ^owtA bv fi«QUcs which may be aonnaL Xeax 
sod fthbjr. mngnitd or vwn ntcroUc- 





lun avf- 

ddtrt) v'ah thxmnc jtfiruiiMiL (<). SigiK of trlfrvrit ia ikr prnplurai 
artftiej. {dU Cy>amm* UiSdiaed edtm^ and tfrvigiiai futpUj, tuif- 
■H4«f tjmpitmt mtJi at umiUltr^t fulUr, iitnftttum or fuvjiiAf. |e), 

wkh hoanencv cv aphoiUL f^. Brgttn tav^ 

PalpRlbMI.'^Kjr^giui/e /WmJuw iMd IkriXi and tkf ^o-foiUd Jis<is- 
UMc thock w dufflf «o be soughi. In ccnain ancunmu in^Glvinx 
ibe mairme pnctwo erf ihc irth, ane m*^ find the "twAckt^il lug" 
£al dcvcriUd by Olivet, To vbufo Ehb. Uw crkdd i^inita^ i« t^rs^jicil 
by the thumb »d io^ of ih« <JMffY«r as the bttd ol th« pfttitnt U 
lipfvd ifith^y iMciniuil. up«aid InKlkOk b tbcn mvie and » tugglni: 
tcwwrtoft may be fcLt -r-Uli tnch cvdinc impidae.* The obwrvfr is 
oIUd nii>lit!«l bj Ihr ]njliaiia«i of ithcTa unrW tlit fingrr itarticufarly 
£f AonJ< incompctcTKc cxij»1s, txtd^ by 
/kttkfJ mtpiraiory movemcnu. Furthtr- 
mtre. ti ii uttdirubk^y preiettt in many 
Arattky prrjofir, attti in th^u ^hv ka^v 
midxni pirn flit adhesions and crfkiirdy 
tiltfnS it ii ivry iarit ^efiorUim a} Ihc nucs 

The Pub*.— Afidc from ibc sJicnbof a 
<oind<1rnT atV\x rfgurgiuiion tht puW , iFiri^ri^m 
yidtb informatian cif n^l v;i|LLr in mkoy 
cBJctt. The obdcfvcr sJxoukl carefully com 
parv lhI^ bcAl b the Ivn rndUlK dW ciiratids 
w»d note «ay (kky or ip<^«ftlity. RouhinK «a they <](i rjlt>tr in^m ' 
prawtirv od ibc »c or drti>nn«d *rl«-ri»l nutlr-u in rhr (>->rri4>[i>i ' 
l*«d. Aicb diScraicc* faiabb ntrllcnl CDm?b<jiuiiii: I'v-Mcncc and 
in kKafijuoff «neun*nul tunMcv (S** p. 171^) 
PEFcmvloa.— fn advamad ami vrU dr^ivi toju pcmuwbn cnay 
fnniA dnrct evidence in ibc farm of mBriicd dulacti over ancur- 
Inul anM. hM kt th^ MfUrr nun ^ ir dntftStft dnd n^jutinf. 
jtuionftotorr ^'vidaixriHi is tmullv morr valiubk thaa Atmplc pcrcuttEon' 
Slfldent and pnctitioner alikt thmiT^I b« thoroughly riniiJii.r with tlie 
nonnaJ Tmnuioiu la the jienliai pcruwobn Quit yicldtd by Hk man- 
iibriwn sicnii. 


o Pmn the rurftd vtud^ a^ a fAfualdprnMr itumboT oT cuts Ifae AUttur 
bdkra itih 10 bv a pvmtj ovn-raird lympiaai. 





Aii»culUtIoa. -A $y>kilk or more rvcl> a di^akUt mnrKtHr. or] 
bothp iTity bff hMTcl but in rive in motf buUnnv io utociftMln 
^ talvukr clivwc. thU bving pttitJCuUt^y uvc of llic dialolic atiumnr. 
]■ •/stdic bruit oflcfi han)i. vibrant nnd ouodiLipd wttk psdp«Me thrill 
[being nnt imroinmAnly yimdumi by iht »r rtnelf rrrMvirr ujxin she 
pulmonary <hTi cry tony alK>aocoun1 for the murmur hcuni The AyKolit 
murmiiN *rt <^Ufn yirUWAy mn^miiic^] alattfi ihc v<-urU and a li 
syatulic licard aL the Icfl bAcL b ilh iiDportiuil si^ i?f ucuHstq 
' dncrnding tbotmdc uirtL Jhf m^st tmporiant linglr rigt. the aafkt^ 
■fijUHUTc . 5^j^^^ ta U A Ui$titt£t riitffnjf. mtifiUk. taond nntrnJ, JkotJ mii t>i^ 
fA# oertU ir^hft ilnJ/; ^n' i^vr tht tac The mftximuni mtenilly f?f iht 
tnic ou- murmun may cicni|jy ihe ntmr suggnillTr itKr. 

0ab}eetiv« Sriiiptonu.— iJyjpum. prftwdM oppruswn <md f^im 



CJnIv |ii-in( n1 [iiik«Ui>ii. II44I 
itkffl tnTlnmrjuicfwilhrntiire 


orr lAf rjhif/ Jt^jvi^v nf n^ and**} ihcit. fain h by far M^ mojt vn/tfvim. 
rAMrvfioiflr, every intyF Aticuritaa dhould be tccomponinl by i/tyrr 
pdtn. oitualiy a l&rgr mimlirr ^ in a IauJ tt^TTQliuiuin vithoui ii 
Wwn pmuit ii mny bp locnLincdH ^tHuae or rcFcnfli ahootioi^ a4tw& i 
or more roinnioDly dull or gcnving. Ir ia atvax DtfAlntfrpmeil n* 
linfflcd u ncurdKit, wh! to (rcalcd. 

Special Symptom » Ace ordiog toSiUof V^VQ.—Ati4tirifM a} &^ 
fint pftiif^ iV "^^ ''^■^^ '^"y hUir^iu-niL itiA^c uitJcr lhj> hraiLin^c 
uc liable 10 exception, but ia jccnf-rut it mny be caid Ihtt ii the firil 
ponkn of the arch i» mtxilvi-d a pululion cit ranrly»nffq«oifle tumor 



to otMid in trcft of diiloMi ouiA-artl and upvud In «ictp4ionjil 
imtenew dw mm (uasio ilimtiwinU. Aitii^ici of Angina pwiorui 
nad Nvere ptipiuiua an common in thia coDOcclion. Tlic 
MMlic nhnt AfT likdy in b« titvnlvrrl itnd njmploTEUi of HonVc re- 
pUj^doD and * double munDUr uc oftca prtacnti A»od«lpd w!lh 
f^oHc thrill &nd niark«<1 diutolk thock. tlxtenaion of thr growih 
tends to cnuc IcKslucd cdcnuu cyAiicak i^a»>-m^Dr Bj^ptoms and 
pottiblj plc<ml or c<» pcncanlul in^ammDlioa. 

Aaeorbm of the 7rAOsv«r« Pnriloa of the Ardi.^Thf oom* 
■OS symplom are dulnoi tnd pulMtion over and abvui ihc mui' 



lA«rUt^ 1>^ t>H iwi 

nbrtun and im the rfistfnttti ir^ifA, rr^^Aiiii/lu^Hr fcHMi-tu^, panJysli 

of lie Tocsl coril vilh wltlfrjirrinc tt>Ei.f and braif n cougti. majkril 

RFDcnJ prw ouw ijmplonu* ^Mh vsriabte (]«» vevtre Ibotx in »EWur- 

isA of ilia flnt poitlon), tyiLCic brutL ikHU, diuuljc ihcrk (ol^rn 

j, lad tipg). pulN wutkms Coflcn nuukod). dy«pnv« uJ prccoidlol 

^^^hpnre^ J*lw rf »- grt twaf>t vuvm arc <ni»nwn Aod midcA^ing in 

pHHoedfaiV witb chb btm aqJ tlic audiw hujt ktumu vi acrcijil audi 

in0l«ac«i l» ivhich for a long ttin# tnatmEnl had bt«ii unjucoiw 

1 hiBy asd raaiaJcraljr mtployrd. 

f Jlfttttrfm of tJu D«MeDdios PonioD of the Arch.— la lliw 
leripa the >jiQptainB are Iftdy in b« pmuni poiorrknHj nthrr itin 
f aaicdoclf. Tb^ fUf W sGtht t^r Ab*ait; may indudc livit. pCKU>- 
I flIoB dalnns, mpvtfidal poMtrior puLution, or, odiui Voiun <«i^ 

Lj^ ^ 







r ClMT, 

{ pofaapfr «xTctna1 pcrfomtbn. And ftre comaoalr MCORifMiutiJ bj* ft 

ak$a of ib'riLix- ir>c-un:.m coming vndcr th« *iillwr'» ftUcfiiM b«vc 

wouM hM« fp^r iinrrcujniim). Ry reference 10 niuMniians on po^ 

7C^ 30Q. ont wUl (or iliat adwanod rav* trnniftttfiig Inmlly m-iiHm 

a fv« mantluH procnlcd i<w or nooc of the lypkt} wgns of Ihr diaouc. 

Mjuiy hftd bMaintLled forvvicnttailinml>.un«rly nnrrittlMto the tr«r 

rauw of the Iroublc. juid ncunlg^ u^IioiAp fSyypcpKUi, daeAae of tk« 

aT>mc and pulronnary lubcmilosk vcrv amooipi the '*iittOTi*it cnion- 

roLitty flUgnri^il. 1i wi^liM vrm thai mir Iilmt in tr^saH loihviyaip- 

tomatoloey ci ihomcic hncurum need rcYuion and dial our diiffkailk 

mflbods ihonid br FrJ^fdronl by thp fin^lin^ of the X'lUyt 

I Differaitift] 'Dinzoo^t.—MrdUsHnat ahc^u. Ilic npid develop- 

meal with rymptonv ol aupfjumtion J^nd inllunnaticc and the abwc< 

, of anRuri«rnAl tyn^iJlonu other ili«n prcMur? sympluma ihrniftrl be 

' lulfidcnt lo csDCludc this Icslcn^ hdmenorj f/br^ti*. Caxs oF fibfoid 

' fdiihifk or any case inrolviDg the reindion ol lung oaay give ritt le 

Kiggcsiiic puIutifFn In uieuruniai jLreax but onfin&ry mclbofb aLoglJ 

C>c lU&cicnl to (sUbljili |ii( actual cnnditiont prcfunit a»d be roinfotccd 

Isrf^ cnvity adjticont lo the ancurismal pivas may prcxlucc 
anJ (imaln nthcrr anninftmal xt^& hut The hjitory. tpuia^ fanwb 
aounda, <tc,, ?li<^ld make error impoaablc- ABvniic Polnrtioii 
ihould be readily ififlcRQtiatfd by ntinrul mclhodL A^rtu rt- 
gwrgUiUtn k /rfytt«ntfy jtwifafrrf wUk anrurUmal dilatalimi boih 
dyatmk and Init; it unanodalcd i\ tluruld oHm little difficulty. 
l/ijJijfjKinf jfTtfvfAj If* JAr iftfdujJifUfM. XSlien these are asK^ 
cjncml itith nidmccB ol nali^aul dioeue cbcvlufe in ibc body 
thry olTer Nitle di^rulty, bui v-hm imi u a«B>datcd they brcoiDf 
most diilicvll CO ditTcrenliiLte. Tttcf may ^Id aE ol ibc prasun 
tymptomi and even puUaiioo in aiieuriunal axMi^ Th« foU^ivin|{ 
puinb aauat iu JifTcTticiiatinic tlicm: — (a). KmoaMit «/ a primary 
/Mitf 4^ Mdr^nSKf ^rwlA. (bj. ^1j«ik« of tk* ««srnU«ry |»(W 
oy <m€mivt. (c). Aj^ emaciiitff^- (d). Ahsfna oj txpamttir ftd' 

« la the au<hiiT*i eipcrvnoc. fui<irvirr. 13^ hat btttt of a remitient cy|ic. 
and Klknd by dUoluir ruu ai Itnu id Ok eady Rage ol the dbeaat 

tOf lime CM*& 40% hAvt dJr<«i!> dind suddenly, Jn tctirr*! bitukco 
Without dcvclopifHC Inr man loarticd ^rmptOOK 


Mim tidier opon ordinur iiupKlIo& «T cDon cttfinlt^ 

hy totmam^ hwUuhLl In iwo cama 9ms rocr^nily by xhe Auihor i < Anrariim 

cettain junoum of uitrarluuAl dilaiHtJvii u*<xiiUii niL^i a hiyx itiniiu' ^ ||^^'' 


•r«Tj In iw n^4lt«UaujCv Kurt inrl cUiirrJ auira irc r<ifr<>«riEC(] U> t^r ilrcprr 

vurJ^ sn>BVtli9 wiiii i^cik CKpuwilo puUflUoa ma^ 4t|>i)<^r md force 
the AifMxddui ta rrij niiolly upon austalTAtory ^'gnx. In mdi 
ioMMon ocrtdoitti^fxnn m ilinpywifii or Failurt in pMicivc dcte^ 
mfauboD Mv unavoitUbk. 






Tiotd Ci>Dstder*tions snd Coaci\uioa&.—C«ntimcjus #/ 
yuU f»tf tym flams lert iM^9fi it krm i n td ^y XJUy gW i>»> tf *w. i/«rv 

Fiit ti4.— M«ltriiiinruijatnjc;iniiki c«idit, r(v«ih<vciipptiiiDridI«i£hiiia- 

jAmiU bt ffgarded ^i nijfidotu -jrlvn thf^ friiHi it) myeimmm M' 
tensity ar« t*ntJtd ai i:mr lUstance jrffm iht frvf^ vaMor ^rm. Tarn- 



All muar- 

frmttaS ^pvU&Hi iketil4 mtvtr bt omiUcJ ttnd itt Joiai4ftd toi^ yuitiirtj; 
pere$u$i4n i fa ko^ Ut* fftd fif cht^uM rat sfiiinJJ be ^iitrmiitfJ. In all 
walhteg CSHS of ufuritm mnj nUting ■tta of duliiftt i* pcrorplibly 
reduced br a ftw diffl of icst, and die ^ImTj vonaMii^ </ firumrc 
s7M/«mt u reelect lo tbe oc^up&iioQ or Ibe purtuiU «f the indtvidiuU 

ikould be CnuidtrctL 7'^ iemftrahtrt rOtfuk itftnglk mod nuitiiioH 
vbookl be w«kbc<l; tmAUfTAi l^s of knw jtrjti i$ sux^ttiht unJ fW 
kUtofj 0) fiu$ rj^iiis rr rtirmiil iipi» of « ctfni(i.1 Irsitm Are tnobi 
anporUnt It aho«ld t< fvincinbertHl Uiil xmi^ fenMniiiij is ojlfit ' 
mmtmismsl. and ifaal arMrf prftturr ttUtraSi^m of the pulnoriAiy ttnx- \ 
tu>c «■«> ffedm* pkytk^ sigm cf M^nvv^ru, vid tinidlj, iKaI whli i 
ibc ttuomKOfJC oee n^jr ntiuJIy *cc oed iKajntely Ri«ft»uic the uu« I 
dcttrayDC Inic cifMinaile pulutloD tod aixuratcljr tcuurd xhc diaa^j 
Iftdvrrd by n«« or ireainmi 

Kin>OCARDn'IS.''DffliiJtion.— An JnHimTruilirmof ihf aidix«r' 
iliuak,M«1C5Dbftcult or chronic* bcfjign or nuUtcnjuit aiTcciicf; chicly 
the qppowd mrfaow ol iheTalrtf. but mon rorcK rhc muntl cndocAr- 
djuBB, •ndmdbijE lupjvducf (T4n»^llalLinBijr|7rriiid^init vtgcUlwna' 
or d*foroihcc raon c« Um «rriiXMly oJIvcCtn^ Ttlvubr adiob. 

Vajieii«ff*- — In i<iaicr»l ibmr are Ihree cbxars: (i). t'crrucMr, 
in vhkh ibr vdvo &re ib( ant oi v«|«t»tiop5. 6ncly pApiUirr in 71,,^, 
Apfttuvw, jellovrbh white m cotor «icl fTimpn«.L-il of ajtindjc celh '""' 
ikrlvcd &i>» 1^ QjifQiV iMbc or tndoihdiumH ]cut.iK>]<». fitniii 
thf«kdi«nd^VMilArtnaBniiI. l1ieyBJcofi«nrd/i^/hvb^«rt<ir fitiriii. 
(3). rA« WitcrnAfw /frva, <&unclcr)ttd by pntloitiinanco auJ r%^^d 
^tl WM to o of A Mootic proccM pitMOt to « di^l degree in the p<1^^clil1g 
fictBi, tbe dfakal fyniptoim* bang br^ly ibuv of Nrpiic InTciirnlnn. 
(jV The $ikf^tk or fibrottt form cfaktiicunicd by jii j^bw d^vckip- 
nefU. ilt ckrooidiy snd iu ^trkAtncJ u> defnrm v^ilvutar trmi'iurct. 

XtidcgJ* — No Ifiedlic nifro or^rism can be dinrp^d with the 
n>pctniUlil|r for acntc ct:4locijiliu!t. The itimiinniVii-iMxus. siaphy' 
looMtiM, MnpiococciM and i&ofe nrdy Ibe ciolon bodlluj tnd the 
bacBI of l&lliiaitt, lubtrrulmft lod cy^nLd have bem found Ja 

*G. A. GfhBos iptly ii>ii; "fi li tm|icimi1>J( ro ilnvt any dtEinhf line 
wptttadnf ihdc icaiom fioia one unjihcr. Tticy form ■ thiila ol vliicli 
tb? eofb. tkoufh cKffmoty dffcnci sra jcl uiiiicJ by LtjIu prt>cucln^ % 
pnfai CJAdntida.'' 






mvn diFB- 

<ndocirdU biloii*. jtdnfe rhaimaiitm. ikf acuU fvrms ^ stplU 

wiiJi bolt] iljt Ixiii^ juid ulocnttivc uuca. The Kkroiic furma sit 
caused by the uune fidtjn u aT« actirr in ajti-riA-K'itrofiuf gmcr^ly. 
It i% prohjihic that an cn{1Lh:Jln)j|]^ cnxin ic orail} tvcr> scicrr tvr at 
Acute rhcumiUEiim (iiA mo»i conunon <nusc) and thar xaany sponiancout 
KTovcrioi fmm intniiktu iinrpmpilTwl Irjiioni ocnir Chlldrrn m* 
taijcdaliy IUIjIc ki th!> aiulc <tiniplii;itrim of ihruuitluini. 60-80% 
fjRwntinfE drmonttniblr Wionw. ]n a^ItiTts the p«r<mUfE* ^ ptotMblj 
&boux si^r>» tlwugl-. a luwcr lig\irt u usu«Jly fpTtn b^ autlicrkla. 
Chora ftiid ncutt tcn»iUitis eitt both tl<w\y ^avHiAtnl nilh ihi> uf eciioft. 
ihnugh In rharrk <'ju*i m*n}' miimmrt >rc (imcni which maj- profe 
ultim^cly ta I3C funitirHial t>r lUruIcmuL Any uf the cjiAiilhctMU 
Ukd f4prrii4]1y KCArlAtEna mtu) dlphihrrlsi mny hr fi>rnfJlrair^ bf ft 
ukd goourihiica io the Actull I'a suiiiclinita amoiiaIcO wUb (he ulnn- 
Im farm- The prpjlmr nnidure of the vcgrUlioat ia voTtiOoit 
cndocaidilu iz^^lriih ;x>uiblF fur fiagmmta lo be vvepl away by iht 
' blood SlKfifn ani produoc emboli m Ihr brain, tunjp or other i-bcciv, 
thttt nccAimiing for vimr nf ihr wdilc^n drjiTh\ and gamfyiJr sHfiirM. 
mcounlcrrd in t^n'ntc heart <1lactbac. 

SutMCiiM Endoordlria,— Thi« form inrwnlA few symplonu. olber 

UiAii 4 inufinur> und fever may pun unnoiiced untcd 11 apprv 

in OR fticbnk inipnid of the primary ducue^ Pal|HUt]OQ aiid m- 

I Kinhijjti \VTiipirjiiii fjf dy«pniTi&> or ftun oiittt a smst ef /wwwAaf 

• cppffjnun All- uMrjhtlv prvwnt thou£h often "vetWkod. All cm$aci 

■eule infertiiltiH fir rhronlr d[fii*a4rt 4itch jitp^nr. dirthrf'^ Htid BrigbT't 

dlicajc should be caicfulljr w^Acbcd : in the former the bc4Jt should be 

examined; M enfh v»ji. for offc-Dtimrv ivrinus vilvulnr Iciutfis mrr 

lOTCiltwked *nd ihc patient U allowed lo he up and about untin om- 

I dilixHiA full '-f dftn|i^r nnd makinfc cerlnJn the otabLshmeiU of 4 chtcnie 

Mon. Ulcerative EodocurdUlx. Thr synii^ju^iitt a/r rNM-nlially 

I thoA of <a). The l)']>h»J(J ^tnte. lb). Of p)<eEiun» &Ad arr usually ckfi- 

I nit« llunigh \a\tr\t »vf« oour. ChUL high fever atvi iwrait uAoeiftled 

with valvular murmur arr the nic^re characlcriMk iealufe^ but it 

may do^y simulate tyfihoid fmcr. tnokria and tEcnfogili*, I^etcchtc 

aic uaittlly ptx:kiiIh muliiple tbHcv formalin It eomwo o , iplmit itimc- 

faction<oftcn ludden from Infarct, may ocoir, gMlrD-Inli«tliul aympUuiu 

may be predoitilnani. and. nLiely, ■ aepthr arthriltA iWvckipa. The 

^ia/ffo^ JepmJt iari/iy ttjum ikf frcscncf. ^ M« dn^/Mwitf «/ # 

^vnifir ItiHM in'fJr sffli(. and untaUy rmb&iii mairi^rljliww. 



CltfOQle EodOMrditb-^Thb penniu a dniiion un6ct twn diitinci 
disMH. (■)- Cua fT>lb)ii*inf; rlinEmAijini or athcr acinc intechont. 
(s). Thoac ducio schnx^licoi (ibmiil ^hitMgc^ icAutiEnie In mi akuholiaui* 
i^pbilu. irout chronic ncptiriiia or mcr» wnUa chin^. 

The nbultln^ valvulMT Aflcnik>ni tiutj cause tb« miBL cilreiiu; de- 
ronntijr or b« ooinparaiivtlv Aligh ^d the i^Enptoms w mcitl^ tboK 
*1f i innWfT'1 niwlfr the hnul of x^Kulxr tlistfLtot 

KRlCASDniS. Th eii^iagk liUi/>rs in f>cTicArilti> arr i>1cniial 
«1lb ibMfr of «OitIoainiiriR Aax\as^ in (hr- prti¥<i^nR (^ii»n, 50^:'^ of 
iW tua bon^ tllnbutflbk ti> rhcmnatum aitd rcprcKnLing chtefly' 
th« ]n>«BgH »^; bright'* diMSM ukI tubtrtukjBi* bein^ ndivv ficioR ' 
puticidadr «| oliirr ign* Tntunailm and illacwet uf mftlnuiriilon , 
plftj a >04BCwbAt Urpt pan snti the arvic infeclSoiu jpAerill^ a IcjEicr 
one thui in ntdociTditii. [nclt¥<1 ir cs a ^ot uncommoQ irmiins]' 
tmi b DBWtT chronic dlaCMO. About ^c^ of the cuet tJt dry or 
plutic Aod nuk« ire chirflr AfTccUd, ft in 1 fmfumi ■coompftiiincol 
of auc9 abowing ralvuUr Icsfuru or may be coiijddcnl with ap ncute 
oCttbACMe twiocwdilia. 

MorUi Aiutomj.— Tht fbansrs IilttilUiil whh thna? of plni- 
r^ both u Ui Ihc nalnrc nn<l coune of iltc mllAmrrulory cbaniEt* and 
te vanfabLt <iofUtJiutkjii ni \ht rjudaie, lirr<e we have not only dry 
perionSlift ifid ])nkanlitB with dTuiiuii, hvK ihc laKrr may be atitnu 
(the oomHion form), bcfnorrhigic, punifral or gaMOUAv 

SymptDDU-^Lilc the fJevu the pciioinlJum fbnns a pnlcntlat 
carily, ila 1a>vrs bctfli; rr.9te1ed upon the h»n and upvrardt upoD the 
gr*>t vtMrk for ftft inch nr mnre nnri iu parfrtnl layrn litrunuTally 
copliiKK'U* wilh ftnd adbcteni t» ilic liiaphnjcni bdow >nd the ccrrkaJ 
iMda above. lt% msn o' Htiitinn fr U (XAwrtftl intii nn ;icti]til rroep- 
iMlecapil^oCholdbi^fiomoneUf lliKCpJnaorevealnn^rfjvaiLiitin 
1a MCCptionoBv dvonie caiea; thua it may fomi uiifam ihe mcdijuiinum 
a nBQor v (use u lu gudc many of the pressure iymplitms fntly dia- 
ciiaaed uadcr aneurUm. pOfp ioj. and Imlhcrmore lerimuty cmlinr- 
mavtiHiaetkin of ihehrar iiarLf And r tie arijjtrrm y>i]lmrmAr>' ^ntntjits 
III doae rdation to the pleura mak<« iia [*rlicipatii>a in a pEruiiiT 
OMmskon. a£ alio tS? jnvnWniimt of the ptevn in a fmiearditit. Having 
ibcne facia In nuniJ iia aymploos suEge«l lliemxlva, Tlier arv (a) 
^^11, often icrere. ib) /a^. (c) o^/irra^ ^m^j^> (d) dyi^s*m. (c) ^rc' 

JfarM pom k pcc«m m skboui tliree-lourtlia of the tvm but il 
variable in il* liie and (tiicnrfty. being fell ntiiiUy thktl<} tntrt N^ 








t tXlht 

unncAX mAGXMu, 

hue of ibc haui. io Hx cpiguuium or crta rtfcrmi to ibt kft vm 
and ahouLdtf u in an^^a pcctoru^ TAtf /amt it luualty nodcnie «nd 
nl wlable dunttDn. iMtln^; (mm a few cUys 10 wvct&I »vck» »<xDrd- 
inf to the counc of ibe InllAmniAtQiy proccn tnd ia of a itptic t}rpc 
if nppuntion ^icrDn, Tk« ^wlrr may not only hf A<tFt«ntH but 
roukcdly arrkjlhcuc, Tkt dyspna*t b olUn matl^fd but ooi dccaaiit 
unlciB «ttiuico o<xuri when it mjLjr even loidi ortbopfioeft. SKj^l 
fjHMor^ may be procni in ihc early :ilitjec* an^ k malted In the 
ptCMBC* of br^ dfutlon*. JV«vrJio/ ^ffrtni^n m^y b« pracnt nvo 
in th« Rurl/ Mai^ anil Is 'miciwtbrtl io large HTualona The frktim 
s^uttds TOAj be tiiislc. double or triple, nrc utfudly beard ducfiy at ibt 
bo£« and to Itt IrfJ of the m«Jin lint nnd are tvptrffiat. mfrMaif , 
*ne. ihugUt^i or ^rtiiing tewndi though at iLri>a amuuin^ die qi 
of ft baish valvular murmur or a crcpiUb'on- 71^ art tdd^m «f 
dirnJty ttiokd Ui Ikx hart stumjt oj mdncardial mNmvf. are likdj 
h shijt tk<w poinU cf mcj^mtrm tHlemsiiy and cAoAXv Aeir fwattf 
/r^m day to day aud art oflm oisotiaUd vHlh n^iaf £iv^ trndrpnta 
^t$d mnoJtd Qttdibiii^y undrr itctfioico^ prr^sufc Tkt doiMe J«a^ 
4$ m^ cffmrMm. tkt settmd pulnmary tfftmd u gfrpiJMifarf, mmHn 
htnn ruj dtfinit^ trarumiinim lu in fndotardial dUeatt. oiKJ. fnttkm frt- 
mit^t^ U oltpa pmcnL If aHutum occun? i1 iLiuaH? f^JMVj the ftn 
, and it mamf^sted by ckatign tn Ik^ cordite cufUmt varying vriih th« CX' 
Iccit of cffuaion bul (cndinft \o asuumc a pcar<ftbapc<J 01 Uungular fors 
vUh Ihr tAx: downward- Tht duhitv it puvt ma^M Iksn in ivrfnury 
dtUioHcH, ih< ofcx bMl ojkn uppojrt kigktr tkan nannaL is vitkU 
iks Uft bordm of dadntsi and rt^y tniirtiy duapptar i« Aarj* €gutu*a. 
The \tcuie an^lr vrdinarUy famed by the fd.iti-r. duln^ss 0/ Ik* HfJkl 
heart tinrf Ike Uver boundary U rfruUrrd obtt4se (t<i»Icli*B ti^)^ tke hitrt 
sowuh offf diminisJitd ovtr ibc nrra oT dulncttt tmd frwstmw tip^ 
become promineni m tbe cduakm kIvadccs. An mUaiitx intfh satac 
^tim of bnaen qwUiy m»y b* ptVMnt. oompruciDn ->i thr Uk \ur^% 
DUy fpn rise Ic dulnay vrtdcr the leji napiJar angU tWiA Ad/jA «r IuAh - 
Xar afwtAih; tii(«if/< ji^n), lyatufis dotpcn^ dyspnam inaaxt 
and the i>aci(-nt U tmially dixUrsaBed. drjirrmed and appitbenRvc Tbc 
Aynipton:!^ of prcuurc affecllnjc mcdiastlnaJ atrucEurcs ^JMkp aos^.tbould 
bt noird, ihr pulu may h^ dicr.nJc or patndntik, and n*p1i«lory 
i«nou» colIapM (mc p. 136) m&y aug^l natoulvr inllanaiiiatory adlic- 
sion*. OccaiionalZy but not dwayt tht Leatcr offuAkms ihoir noaHicd 
chuLgcs in tbc \c\jd of diilneas vlih changes in poatim^ 
Claronic AdbesiTe Pericarditis.— Thia common aequd oSen gre«t 

diffimldva^ Ocm^DnaJly u in jJruriilrs ii is mggnMd 
pcnUtcncc of niodkfiod fricdooi over ihc hcan. H cvlcn> 
the dUpbtigm may b« *■> di«fO|cd upon by Bdhedoru u to 
alunr the odc jalliiignunicutc: ujEn. ru.* tyitfi-k mr^nm vf Iht lirw 

tUU^kme^. Su iho ^hvn• way brr prnuiuil s^olit: filliojj anil iJiaieKnIic 
coUapK of the juKuUr nins^ In pcivaicnt ftdbeoioa then is a diUlatioD 
and hypertrophy af the hampcted heul ranch 1t« rnvorsbk as n^gird* 
proffttnii ihbc that of tndoctrdfAl dbeacc- 

DtogBO^to.'— Aside froTQ the fafion nvniioi^Ml ihf dJAgnf^It of 
cffuuni nkay reqniic ibc use uf an uviiatiit^ iiirdtc uf stuaH ^.olibrr 
irhich b iniMt vidy icUi^ducH in1<7 lli^ trevic« tonncii by the auaform 
and th« rib nttr^ on thr rghl tidr. ihc nr:<^l]r t}dng lEirHinl lo^onU 
tbc poim of the n'jcht ^cnddcf. TAu pfG«ditrt is not tc be underhktn 
ymiat pr^mplfd 6y not fuanily. The bng pmiiictire oi an cffiuian 
tad tbc ocmreacc of a septic icrvprnture point to pya-fmeanHHm 
■ad tirt tutaliliaio& oi marLcd naunanct (of tb« fonn of Un sac), fior 
the chibru fiunix to ^iwwwtf f <rfc ttfJfw »> an ctcwlvdy nnr cnntfiLkin. 
While ibrcccLicslly ftnd bdced tumoUy ihe dinitnowA of lUa oonilidon 
is iimp]r. In praalfr, atfrn of ihr iTimnsi itfimli} may t>r mn-inrfrrHl 
and more ihaA ooc luisbly akilkd dlDician hu introduced ihc cccdlc 
into a dikl«rf JbMff unally. lcatun«iely. vlt)3oul urfous muJl, ll fa 
iMCBfluy. thcrdoTT. Ip Uar in inhid the pcxdiar fuEuxa oE ptfUatdi^ 
cffufioii dubctt, ib men marked character, its grrorcr upn-jird f xlcct 
lu i>cndlar fonn and fis crteaanD btynnd ih^ apex bcAl if thai be Ttaf- 
ble^ MawJirr lonjt slaiidinc cfljMons liavc been miJitjikcn for tcfl stiW 
plenrtilc*. ftydrO'ftrUarditam ocom at a pAiT uf gmtr^t dmp^ysad 
tatddom Tniatakcn foracluoJ inflammatory c^uumi bccauK of Ibc ono- 
daled coa'^ilkmt ofrd the luual sbscacc of laimajy To«r.* 

MYOCARDITIS.— The diaeua oi the raytK^Mium ttmy be divided 
Into acvt« and chmnic the former occur diic6y in conacction with 
xhft mcrrr teams, lA Infmfoiia dfKwtM audi aa (railaitTii, lyphnJd, 
lyphWi BkalifD^ni eiKlocardllb and wrplic inloucalioriA in funeral &ncl 
coasifttite ODf of Ihf caosi coramon utd irr>nu» coTn plica licms of 
diphtheria, and ihc hcaft may obow cncnnout dilataiion. almait abao* 

* To a CUE obwrtt^d hy lL>t ulhor tome yctfaago ba uicuriua«f the 
AOrt^ arch ocmpy^ Ihc ri^hl k^irfr (best and aafeocuUtd wilH a nuikcdly 
ukI ditpucM h»ar1 closvly «imuJat«d la dw ch^nrirr knd «tt«rit of 
a Biorkfd pctkOdUl dTuidon: fonunatdy (ha uunrttmnF aEjeiu w«rc 
MAfkotly cttilinct te prrfnnl any rrmr, rhnii^ fnrtifln kau niln aI c&rUxc 
iliyihM «0* pfocn ac lie te«D. 









xilc ine^/Ticjcncy. or indctd produce dcftlh iosiAQllir or wilh aHch 

i VTAinfnj^, 

I SymptOQis of Acute MyoCBrditb, M«rkc<l AnhrtluQEft, |ttlpiu< 
Lion, irrtigo nn<] wvak, rtjiid or oscvnlvdy tbyit pvtat^ dyspnoea. 
cyjuk«b and ilJininis^itxl uririt iiiajr be ausodalrtl •mith a dm mind or 
in vnnc coan ddtKum. The twort ffoundi an weak, [<euJ «fid brliinir 
[n dotttikI acrmmjirio)] mil [hrrr » luuitly no dUHmllT In t»khi|E mit 
by i>cnumi<>ti tbc uuilfne pmvinK dflAUtiori, 

Chronk tnyouirditU mAv acvomftirty =— i.a) r^emary idtrutitt 4m- 
tcJijirr tfr ikrurat^'^tj. (b) thrtmv vvhttl'tr ditaur #r irmik dcgfKtrnHfim 
prodtuing Ihe cendttwH kti*ntm /it bffum alts-pky, (c) /oir^ optrprnHk 
tmd faUy dtgnvralion. tatiy ovi^tgrovrUi bcki iht mUMjd degcnrmhr 
chADHOof the latter form lhoU|;h mejled fatly indllFitbn may inpttif 
Ihf ftini.itnn nxid nutriilnn of i^e muule itnH may rwn AlTm th^ (utpil 
Ivy niu»de oiid cndoeafiliiim. In Utth eitiir? tlic hnil ii M>fl. ydlow 
and enJargetl. In a<liu] fsity degrfientJoit ihf d^iitrk' Abcra tb e ma elm 
Ahow £ruiulc9 and uil druplrii 4nd dUapp?«tai^ce of nudd and lunBa] 
nurkini^; boih ooaditiona miy be a«Bodatrd with yrimiiy nnaiiiiM 
obMiiy. a rarheik kwc and untie atmphy. l>ijr Hrf^meniinn may 
also oecompany pmtonj^d kfp>j» or M>tre intfecLirm^ chmok bypcr- 
iTopliyi dilaution, pnirardrti^ ronmary iMvmtt nr tirioua chrank 

Symptoma.— /^fjdfrrwJiW anie morlem dtafcnodiof fam-licarf iiaci 
dom iJOfitible llkou^^h the a^r ol 4ht: |>aiJmr. ihc hablia. oi Ur (irfanicr 
of obnity may be augftwtfvc. On the oilwr hand ibtre arc maay Aug, 
gr^rivr tymptoms a^ applying id rhrenir TnyonirrlhU in j^nual. /■ At 
arkriouUtoik €^url »uddcn atizicka uaodated with p^im. varyinK from 
a dull ache ta «Kftvme argina. nuy be ajMociaied with infmtW ivttriai 

\ ifiuitm. no ddubl due Ut vuui-motor apasiu- Such ccoiliiiuns &n fit- 
quently iToriAilciiy and the pain m^y be wbslilulcd by morM ^roCOT' 
dUi iffpmium ur itniti o) sugtHtitit'ti, In the man srvrfr tir (rnnlBal 
<ahM4 pti^fwn4ry iJarta U iim/Aa^ ^yjwjij extreme and the patient dks 
nirklenly or lapse* into uDevntdfin^nrsa. Edfwji or g^watfJ aiUMRtt 
. Niiy be prticnl M is ^fkn taf:kwt:. En all Tvicdca the ptdjg aiay ht 
markeSy ttrrkylkmU. unf<qiuiL -stui van-sftlt m lo imsmi, md Jk< ht^H 
toimtU thvw abntjrwuit ncumiuiitinm tittd MtmUy a jfltfaffdfty, Tke 
fnl iotnut ai thf aptx is //v^inmriy at/wii of grMliy dimimish<4 and 
under Ireaimeai a Timnnur may apjxar and (he tounfl b» pofllafiy 
rv-caiablUhcd. Syjii4ic murmurs, moat ccmoonly <d the mitral and 

^ aortic <irificr, are (rrquaiily olunM^J nstd hradjiau^ia or utckycofdit 



J^f4f tf^ tir Jijfui^ 0ff« 9/ the mni tJunuitfittk frMuftt i% ikt f.uttirt 

.i-ihir* mstu p*f 
4| V«ir. ■Wfiulvtlnt iroicb~9**fi'"r jKri- 

tfr §& ftM, In tbe eorlicr tfagv honvrcr tlic Mine ihrnptvlk 
ordiiwj? mJTnUr ktuM nntT wct^ttil hcft. The tcimin*! is^n^v^TcoiV^ 



kprntr li 


uv merely ihtMc of erflrevM omUac fAcirmpmjoJtffm. fmiucnily tno- 
dttUdvjth mtfiKO ftdcrU or other tvidmcc» of vaso-molor tpaitti; 
ftttAC^i of SBMti dytpmara^ somrlimoi (omtn^ on iluring ilfvp. irrlktf' 
ItOli Ofid */ >uit^ i^tjiA docj rivt iKitrX'Ent the ^raduai dfX^ofmtni 
aj gm^ni ojwjjn'fl. A» mcffHovs mumbet of thrst t^stt art ^vrifviM 
and JaS U> ttidtK (/i« <^fly ^rvo^mmf vtkkk m%hi ja»< muik tMjfmmt 
and pTfflon^ t%ft and uitjtitntit^ M bofort autvd fh* vM «mr con- 
si<irH in ihtf failure lo rlfm^ind tb« nofrait htui «>ttaib En aqj om, 
too grrai sircaa bcirj;; Liid upon inurmun m indTating bctrt discuc^ 
So aLvi mnuj] liilfltifion maj entirely ac»pe obvrvAllon.* ^ ^tmi 
numler cf iHtit cojti ore fucotrntatJ m a^ttKCihn vdth ciitam4aUcU* 
ism wd iadttii m ifn^ ttka ^H )ar fnm britt^ WJAir fioati^at pr 
iuiiriliuil lintnkardif. 

RUPTURE OF THE HEART,— Ihii rtmdilwt aeims Pidy m 
ptis^ms hd-iHrtg ii lifgnt^rittd hr^trl t^ustlr and in lurh may mult fron 
t TaU. fiiia.ii\ or oilier Emiinuiisni , 9Uch u Is nppoccDlly uautfldcnl 
(0 produce luch am jirdilFni, Usuftlly H oarnn in rhr anirriorvtH 
qI ihe Icfc verkinclc in ibc ri|bc tnd cauM« tkalh KiataaUy oi 
within a («w nomtfubi, (^rrcctvl by Brvm pajn. opprrsdan and [^ftsp- 
tamiof irjikiyic. This t-oncMai is mrLlitD-Iegdly imj«nanT, 

AftEURlSH OF THE HEART. Thi5 nK condJEior nmy be 
uocuUr uid B^:>dflicd wftb ftcmc or rhronlc cn^norditis or myo- 
cudltJa> 01 doc to pcricAtdkl tdbcai^^ or gunim&l^ A*i n ctmiol 
CTirlotiTy diiafctlng uwuricm miy be i-nr^unlvrvil D«aih occun 
ubuaIIj From rjptuie and (be Jiacox uniiut be dk^DosUi^cd ^ntc 

F0RET01V BODIES IN TRE HEART.— The ^tpat to much 
norc toIt^FTini rhan r:? iccncmlly Mtppoaed; ciplorinjE ntcdtcA, arviiLg 
ncfritr^, h-.\t pins nrid i-n>n fi kriifr nr buTlrr may noi <auM deaih. 
indeed d Hmall ncx-llc niay be Ltilrodliccd li^ilh a niinimuqi rak ot « 
falAl muil and it lut even b^n nigftvsrcd or aduilly eEnplo^Td as ft 
Lbcrapcutk dtrttier rtirari ht citrdEaii; »Lin)ulatliKi ActonlJnf: to W. 
Q. TbomiuoQ. war records ihow tn utotiliiMnK tJ^Jnpium of Itiv heart 
(rom hiiHri woiindft ili*^iipli i!ir imtpmfTti in Jiatrd ti|v>n Thf CMl *i»r 
rtcordfl vhifh anlcdaicd the ua( ff liifh pcnctrklJoti projectile*^ 

IVEW GROWTHS OF THE HEART.— New gnWlji. mbcrra< 

* In 9 am obnnM nni Icing tincw >r nirl jdtirnf wrafu to bU d«aik in tn 
cxtrrmdy Mgh aJuiudr upcin ihf bnili cf npm f^tnioc, ihou^ to ilw 
tutbur'a knuvlrdp hr hjid hjid ^rvcrr murTriU mtr^inpiTiiulJon nUb 
marked U«wton 3Uauiioa« due to jjajucaidUiH, iu scv^iml jca& 



lufa- ajphflK T>Hom Innna of nrconiB »th\ csrdnoni»« *nij mniv 
i^nJjr the myomkta, lymtihDm&lA or ^biumau may i&Tolva th« horl. 
ft mij be the iral of abirm rn [ryraifii, maU^nnl fnilociRlicit and 
acute nxyiKU^tU. of Liie scat of dcgcacraiivc ot qr^kcfcus cy>l5. | 

SITUS VlSCERUtC IBVERSDS.-As a ptn of the gjmtril 
L->ii»iHmtkm of u£Kaii» <iccMhm«llj ub«crvcJ m • coni^cnluJ pUtiium- ' 
cooo «c tn«)r Bnd the hmrt upon ihe ri|^it aidr. tltc IHt vrnlridc 
hrini; anteriar ami lire sptx in [hr uh»] tclnliori to the trii^jilt il» in ria Ciin 
Mvnwl poailun^ Su^ irinspoAib'cir U samdinn caiuplftf as rtjrnnilB 
thf other orpiu. fiMnvtiicM partinL Appnirnt inmtpi^-hirion of ihe 
hc9f1 IS oDnuon Lut unully pvo^ca lo be due to a dxiibinaticn cif 
UBttilffrtI pfBMun and lack of ituppori.* As a umponry condition 
caHraMK ilcfEma oj dia^bcciDn^t may be awr^uilcd ktiih jjcuraj 

ARTERIO*9CLER0SIS.— D^flnStlon.— A fhrenic rftgrnrrilivr 
choTf^ mvolviojc capcdoJly the orlcnolcs ca the one hand aod the 
Ur|l»f blood voafb oo thr other. Ihc two cotfidEiinnt bdng inv«riftbly 

Morbid Aaatomy.— 'ITie artvrioint an Ihe seat of urterw capJilnry 
Cbrcais^ JTrespntiiT <if (he nrdcr of tht dpp^crativc rhnn^'n, the 
adoihdial and nib ciwk)thc:JiDl tisoucft, ihe clastic bycr and the 
media bdnf tevoKvd, whh Tcnildng loa cpf riMHdty. ft 1u- 
aciiinf[ cf the calfibR aad bcrtaJcd pcxiphcrai resistance- In the 
laf^N' aMrks [bcir ii a cvJlular ififillntion about ihr vun vai- 
EVUiTk. laiuhini* tltv sublatiriial and mrdbl Ihym, >vy<tL is futlowrd 
by dcfSFoenlMfi ai>d necrotic thcjigtt lending lo weaken the arte 
fliaJ wiJk. Should an fnfJiratinn noiule imdr^r;^ fntir nnd hjmline 
ilc|cenenll«n tm qflfcgwnntfJin «tj<ifu i» famtc^l which may be ttun- 
«nt«d fato an ttktf by n^fmAti at (hr rndothdUl wrII. When 
iafillnbc4 by caltaievut mjiller the DoduJcs Fonn the welJ known 
a$ktr^m^tmi fta^mtj. Ita pvocvt may expend ao far u to I'onititute 
a Wfiife 4lirvPtM with 111 jiipe-^itn itsk'Ik. rtgid Mtd torlUDUn b om^^ 
a» (CenbivevyaieedpefKmaoTlheTidiinacif/riinndJUryficntliEf. Pkit^- 
(ffm*ris k lest mminnn btrt may he tnarkri. The ^^nn U rhc nvul 
fn^ueai vile of atbcxomatom chaA|Eca moA aa artcno<«c]cTOlic procoa 
io th* c«rebnJ axlvHea ii ihe most frvqumt catna of apopI»ty. uwatljr 
bmune of anevtismal dilAlatiuu- 



■ta a <vw Mrs mth Dr. D, J. MrrtJtl. npfiamiT rnmpilrtr ilmoUrcmFJit ' 
as div li> vlnaM omfArir tubcrcBloiu cicavaikc of ilic n^liT fuii^ it^lti L 
Hvaow hjpenrgphj ul ibe lert, \ 




[fin bit-. 




y«jiit fofi- 


I BdoJoCff^Apaiti onv (incb th&l Vccua. BaccLus* VuUui. Mvudoo. 

. \Un or M ErvEvi. Stay bf held mponiiblp. Ihougb «ii:h ronAkkiBi may 
result from iJiTtflc ajrcing formbjf one of the nalunl tcvminatkifu oi 
ftdvancH iLtc. mil, on ttieothcr hnnd, may b^^d^Lnfily hrrediury, wifw- 

Afp*i«, Men are &fftrliH] br nu>n fTv<iu«i)tly Ihan womvn wad tnon 
or ktt chjin^ in ihir bhod vnsrli muM 1>r r.r/wJnf in mrn who ham 
rcachccl the meridian of life a-od in many icoUncni art mvc in yooMK 
men ftnd rven im chMtrn. Thut i^tUr tmttiStilf MSfs cf j>wwiiHwi 
«r ffffsfiiims ifftiltty »o tot m ihr blood iTVcb Afc ovKcmcil, 

(the l€iT}[.<jTa]>i rai^rcially so) , acul ufTi!»lunra ihow a fAikation frac'iaibl^^l 
I Uial &«Ti in dortk legur^tation but mem ^vmn/fnn. la marfc^P 
I CUA tbr Dprt bal i)f ihr hnifl lit rliiip1aci<il ilownwanl and bn Uv 
, Icfl and Uk h^vinf: btal of hfpettro|>hv mny l>c pn«iM- 
I Pmlpfltlonv-Ttir ^n^r rroipniu'E readlj theihicbrned im«rpol 

raryiniE itKiriiiy* whkh may bt nAM umlcr Ibe finiDcr aaa dUtbct 

Ivht when the artery u ihut ofT above jmd thr nodular or pJa<|u« Itke 

irreiriilnHiiH trtny he notnl whr.n [irrvnL 

AtucolUtida. Tbraorlir-Kcond^Lind i^ihArplyeeccnttMled, and. 

M * r^U' 4 M'Miilfr mnrmvir in ih<* anrtlr nmi fiimiilnitnft aortir tarn- 

oaU b«i[ dut lo the ruLKhencd intima may be pmcDL (See afao 

pftdorirdui-i ) 

General Symptonu.— Mnny tniriou* lianaitory ai1ack» mn; bt 

eipericnccd, ihe ohjci of which a *ertijj?o, though IniiMloTT spaa 
mndlr wijMrra. mnnopTrRiflu and baTniplcKifti may ab*) ixxiir Apn- 
plc^' 10 uf fourw nJwnyA bi (>c Itored and if Ihe covonary ajicrica arr 
I involtfpfl «i1ark« rif aiigiriA |iefi(^riii and fnirnniitn)! nTV^ Irrrfcular 
pulse arv musl liDublewme^ As a gmr/aJ tvndiltMi arlenv^KJeroab 
hada to iipcp|i]eiy, Jei^nrrBlion tyi the mrortaiy i^ttcla and atjiKMI- 
dllk, and i» inirD.iiEiAL nrplmilL Tlu^ 3>'in|>ioin* mre tfa diMindljr 
lhtj$t of avDcJaled or dependent Icfcioan as to need no eEicnded 
daarrfpitnn. In ix^ athnvrmatoiia form Ir fa thr i^smtiiIaI facior In the 
pitKjuctioin of oncLmain. 

AIVG1TIA PECTORIS (dobr eordi*, hfmrt |)aog) —Fnr ptiq>A<M<a of 
cofivtniiLirf ibih cimji>Ic'X in i^tcfi a place by itself, /f is twitty 
aiuNiys a tymplimttyi rintrio-scJeTDsiA.lhauith mAr4wd degraca of Mtanl 
ileKrncntlidn nany i^l and [\i\n ^yrafriom be abicnL Pcnona anb' 
jeciod lo ecvarc mental strain and nony, who ha^o rmdicil or are 
ncaring the meridian of life. ar« np^rially tubjKt (o aitA<ta and men 




who TPOHc widi Owir tntirii nwy be ooanpofBtiwIj fiw hem ft even 
tbooch ihc Arterid diftafcci ^n nurknl. AlUciu n-wy be fircdpiuted ' 
by violent rmotlon. luch u (nr, siijter, jfrirf* ind, m>( hfnv|ucnll^. KhIuau, 
by vuiUn phjwotl ^sirii* Whru palJniLb air ^uLjl'lI lu allAikb vciy 

So aJHi arm over -««liiig. 

jBght inllavnCM may bt idriqualc ciubm. 
pidi^rsiiiin^ ihmu^ fennntlatiTr cfaangrs uiil duif niuan of tlic slciniiidi 
mvf cftUK an atlack of 4Bfcma or dooc the cuthly nircrr of di victim 
of vnerioAclePtfds cr mynoudltlt Sudden desihfi of ihU kmd nie fre* 
<|ucnt in Uic expcrtcsKe of eiay cwoncr, 

vf HJbr AcvH. anJ « Mvur oj impmdiui^ dfoth. In typital laym flu patitnl 
U r*i^> ^pprfktmtipr, faUui tmd ptrhaps ptrspiring, and ituk may bt 
afraid h spt^i or ^ttoiht u-iiUr iJu viiioct prrttiti Ii a Uiuully of 
ilMrt duntioo Bud ^ ojtcn clmmctcmik^tU relieved hy «uch n drufjui 
aiayl nltrfDr. All tktu tymplowu ncy . tu-wnfr. bf grfuity modtjUd ft/m 
ttt ITM anaiiki^ and Ac Urm ittRHol »W/ t<f timitoi Uf Ihr iturrr <a$ci, 
iDM^noffl in tthkh tbm it boi mndenlv oppmuon may b« «DCoUBl«n4 
and i}v ;din v»nH Eiculf fn |[>rtltno^ trfLUKmiuion aM aetvtiiy^ 
It b iiAuTly auxkied witb tnarkcii QfiprcMkni; in cxlrcn^c cues thi» 
nuy ht dmcribni S9i mishlnf^ nr ihcr llkp. ibooilnjf <^r achlnjj; 
orlcnikjn u> the kii »bmJdcr and arm ia cc-mmon, nnd il may even be 
loc*lif«il In thf rifM vpptr chnt though Ihii iv Jtwt iFvt^iit^Tiily tti« ca««. 
Astoctttted LeaiooA^^Thmi^ nitcrio-Mkroua ia Ihe chief lausr 
ftfl^pa ott<!n iicccmpania n^rgiifcnt isiana of the ftOflic nlve. mitral 
ffl^KttU acute noniiii- rhtmir myocardJlis and anturfitm, fn its' 
mMtr ffinm U may harMy be difjerttiliatfd f/nm a piefttia -angina ov- 
em^mtfrd fn ^rthu of hyaitw*^ nnitaHtimUx and tfruiin Jarmi ttj 
dytptpji^ jr oiiotki rr/dCrJ fir itv «jnr»jnr ttM aj ak^kat and tobacro or 


THK ABDOMEN (AMa., 1 ron^nl).^Exr«plJng th« brain ihts 
n the moel Umctir rei^ioD ot Ibc human body bc<auK af ihc ^biftmitp 
air containing, obccunni inieiiiaai coiU. itt inacctnbilily to direct 
«U4ntJUtki>i, and, the cornpiuaiivd} i^lJKbl value i>\ <c:naln of ihr pliywuil 
Ricihixla ao wluablc in ihtmidc dbcosM. On lh« othci band the 

*tB a catc rrcntly DbtRrr^ a trria^ nt ■liii'kt Icrminaiing in rcrtbral 
«nbu1u» and dtath foUivivd j ilrerl nr nrrldtoi involving a tudilrn nop 
irtiiCk ihmk thr ]Mllral liacLwml viiih «uti fartr u tn «na|> thr HolfUnj 
amp btlcl in hu lai bnod. 


Vantble in 





wmictL nuflKmn. 



tcccnt dcrdopm?iit of the UbotnE^i^ vdc of the subje^ Iu» be«tk 
rerufkablr botli u to titcnt hud ptuttad vaJac Ai tht pn«coi 
.time, while one mu«t tJlmil i^«t poiltivt dJ»|pkoitA a ofm tmpo«aUr, 
itb«>'it)Anytn]« that, looofTo. r«(Aur»n i» hiid bodJ»^Mciibj aorgpr«J 
cxpluiBCiuii wLtliuul atiy ncrlum pndiiniiiAijr Aiitrmpt lu exhaust the 
mon modem [Dcthoda «d pur«I<r lIl'^lioAl diEif>ncas. 

Topo^nipliy nod Rogiootfl DivUlaiu,— Thir spinr. the krwcr ct«iu1 
mbTfcin, the iWnt crcn, Fnupari'i Ufcuncct And the pubic »ri&pby>te 
form the £ii[^nii:Ul boLmd»rie» of the flfadotntn and tu csvlty h toofcd 
by the dw[jhT;M?» which bljcLlCA uid impftrts itvpintocy nk/trmeiat to 
tb« livvr. iL|;l«-n.unfl, to a Iru ^j^tm, thr ki^lnryt and nomick. Tbe 
upper jimii of the c<ni(j is Iniiicai«il by 4 Inuwrtne line at the kvd 
of the bwK of the vndfono. the lowfr by the tnie pelvic brim. A 
wrtfto/ ItiunrclinR a Amamioi line nl the nnirl dhlrlet ihr abrtomm 
Into /mv quadr^ith^ Tht ufiprr ri£ht ii.^\MMlni the liter. ^.$.11 \>\*AAti. 
ht»d of pancTr4«. kiiinoy. the htpatir Heturr. k pc-rfion of (hr tnurrtM 
colon ami Ike pylurua. I'hs iefi yppf. tlic left cilrenuiy of the 1i¥«r. 
Ibc i^le*D. iplcmc flCKurv, a part of Ibe Iraiuvene colon, [eft kidney, 
ihr fundus of ihn tinm^rh itiid mm nf tlic puirrrif- Tftf rigki toKtf 
coninIn» (he n^ cnilJnK <o]«n, ciECum and the vcrmifonn ft;>pcndix, the 
Tnft |i)M'fr fhr ilni^^iiing m1i-in and thr- HJ^mr^Id flMitrr Utt wrrrx 
and ovarie» an anaiomicAllr ^'ff asd not obdomi&ftl and the Icaocr 
inbevtinol coili occupy the vhole lower area. 

The anterior superior tfira. iiki cmt. pmbk t^*, hnr rtti. 
rmlaJ margim anci M< tnsijiir-m uri' liic rliicf. bony landmarks. 1^ 
iittfnt iiitm, thf mn^ And ihf nriuiir miLffirc. dlvtdnl Into ir|^ieTii» by 
ihc linco: tmurcndc and bvundcd calcmallir by the Unm srmiluaarce. 
aw eattily dlMinguiahable in the abdofnen of thin perb^ru. The ■«■&■!* 
KM usually Itu fmm on inch and a half to two inches abo\« a Unc 
conneclinK :he anfericr bupcrior ^lioc npincs and ia oppocilc the tip of 
(he jrl himbar Aplnr, ami. tbr tofA ami ijfk ri^ and At^projeOiomfgf' 
rt4fifivtg Ittif <^h t^iiagt tuc aUo Imporlanl tandniuika. 7^^ abdcm- 
jruti riortfi bifiircair* <>|:ijKMJ]e l}ie 4lh lumbar mtebra l^irrr 'fourths of 
an bch Xa the kft nf and below ihc navel, and the ilium artd j<jimmm 
occupy chietlv Ihc cenite and hvtt ponion ol the civtty, the Jliom 
hu^y t>n the Icfl dind Jcjuruni on (he tiftU and bebw. Th* tiolam h 
\em ahitltnjt and movable and a»c<ndi from liie comm upwards to the 
right, then (hepaljr firitirr) Itatuvenely, crmiing nbovr rhe umbilicui 
[lEnnortrw coJon) under the Left covtol morpn and {^F'Ti^nic fie^ttire) 
downwards, inwnnli (itocending cshm ami flgmold flEiure) in term 

uqsEJUtES oT rm uvm A3m oau-olasdks* 


iBAtt tn Utf iTcUinL The bcpMlic flextiic Ua under Hit nrdi uf ibe 
Jh*tr, ilie q)lenic rrcn hi^ier uadvr tW l«fE ribk Hie traruverfie 
coloiL, dffoM (Inurr «Dd orwm *rc reUtlvrij miprrAdjil aiuI thr 
f<rw»/ y af^dUix Lir* widi lu boAc «i a i>oIni rqiitacntlnK ibe blcr- 
uvrfro nf rhc mitrr Hgp M ihr rij^tst pwitw wfih « iinf rlrawn from 
ihc kUtcror ftiipcricrr IIibc spiiic to Ihc umbilictLs {hScBhfnc^t fcini). 
U tie* bvhisd and to the inaei tide or the cRCum with id >p«jc down- 
ward. Q«Ek«rd. lun^iT'l oi rarely upwnrcl- 

THB UVER AJVO GALL-BLADDfiR.—'nic rtcjinaJ pcrcuMion 
OTitlioc vf ibc Uwx M dhomi \tf llic fuLlinrlng tsLb.* 

MkkDr Unc- 



MldvdUuy ' Sctpokr 







Sixth nh. 

tcknr hftK of AboTciic bp< 
ilpmEd. , lovlu 

Highdi (i1>^ Ttnth rib. 





I It ihodd alio be mUtd that th« left Kobe vilcnds nurly to the left 

^^^faplr, tltt intctf'itar nriirh l^fng in Ihr fim-iIU^l liiiu. Tn thihlvrn thr 
^^^■r lira 1n%tr, iix nid pcrKina ximclJnH?i hi^cr attd in others lower 

I Th9 ctll-bUddcr Iks jiut within the piojct:lion of the 9th oool^ 
t-^rtH^g^ iketr Ibe outer cdgp of lh« right raciw 

The Kpleeit Ho in tbc kfl uniet quiidrani just ont^dc ihc spine 
in dote rrlitbn to the dJaphmffm oboiY. the tcfi kidney, poaeriorly, 
and ihr coluti. Mnm^ch ^nd xmAll iDlrfdnca bdciu. tl In oinl. flat' 
leiKd and b JenjcCh irum throe Ui t^ve Indic* tad it lic« pftiaild to uid 
vMihi \hr uT* of Ibc ^Ih, lAlh «n<l i <th f(bl« hn anifiSor mArgtm retch' 
kif a liof dropped £r>om the atrmo-dArioiUr idol to rhc point of iht 
nth rib. In l«t>'thirxli oi its nirfftcp I'l Js jurircil. 

The Kidaejn-^Tbcx lie iii np|H«iiion lu tlic pintcnoi volU bebft 
tn »Alac1 above wrlh the li^cr 00 (be npht lidc ;iAd the Epl«n on tht 
\Ht afiil now with naptntfon, Tht rij^i It, fJij^hiJ} Iciwci iluin thr Irft 

• Ltuuibiavofi tnd Ruy. "aiii><al Mctlwd*-** 

uPKiAL ouCfiDeua. 



■fld C*cb Uh iwcKhlrrU vithin the mid-clA^'ifnlAr Linr, the lo«r«T 
of Ha ri|^l bong one inch, iLal of the Idt it mthta abcnv the 
PMlcriody, they tic wiihin ji pamllebfpvn repn««Dird by two tietticali 
rinwD imprrrivrTjr unc inch *nd two uid Uirrc'lounhiuiirliei tmrxt ihr 
apinom pncea* and Iwo bohvirLtalt rcpTwniinj; the itIJi donnJ 
arrt ^rrl ^icml^sr iplnc*; ihiw *1»l]I rnr-4hJnl ftf ihrJr turlurr ifl rrwfrr** 
by the ittfa «nd lalh HbAind thri; lower extremity Jka from aa iocik 10 
in inch And k h»Lf »hnTr Ihr err*! <4 tht ijfam. 

tin <jr subdiviiiont of clinicii mtLho^lE arr app^K-^bk lo this r(|^nn, 
T*Jkr ^fji ikp wtic-n lime [K^rmJu (i>nwtA ia ibe aefmiMutnilfffii */ d 
«Marli<. a |iri>ccdurc. howptYTn by 00 mcOBS aJvajx cinp1c7«4 nor 
IndeM fkfcrvuy. fnr Im chlei puqinac Ic 10 rrmovr nuusn of hral 
Bttltcf wbkh mj^ht be miAiakicn for abdonunml c^JHlhs an<l ia aamt 
in%ivittt ii bu (br poBillvp dindvant*^ of procuring gasrous diftca- 
nlon uid prvkdigHl poiaUllit uiini^ whidi mar ohscuir the Tmi 
rJhc ajihide of Ifac pattern is moM importaiir. The JH>dif o>»i 
dtn. fcriittitariy the fvrmrr. tbnulit be wdl r^JacfJ, the fm finnlj 
placed, and ibc ji&liciit blnuclf be in a secure* caay &nd uncaEUtnined. 
donaJ pmlun^ To tecUTe muicular nlualiun of ihr wills U it tuu- 
•Uy necomnKfidcd ihkt the kneea sb:ruld be dmnn Up. but often. Arfftr 
r«^aJ]hM HKiy ^ Ajif utfA Ike UgS exitt^dtd or hut tiigtiMy fcrtd^ Tht 
hrr«lhlnjt dhmbt lie esKy uhI nAiunl w[lh the moulb <q>cn aad tW 
l-aticnt^ attenibn ihouM be divi^rtcd byccitvcxBMkNluulfinquirTridii^ 
ingio oihirr phaart of the r&M- Tbe pftlpatingbtftdiahoitMbe warn, 
tlic li^t afaculd be ndtquatc and its Hurce behind the pMient and fio 
dothing or other mvrrinji fmbamu the «mnJner, Tie fict (6 tht 
Iftlin ftii^ fitiQcra, nul the lipt, thoM te utfd and Intdtr artat iltnJd 
mtft bt fmmnUiAifty af^nm^hMi; nor di>M the diKoveiy ol ftn9 juMify 
rcpated am) purf^wlrw pundiin^ amt |mkiTi)t. /-r palpoHnf mmtnbli 
i>rgiM$ or gttm/ihs rftfirohry rrK/vemeiat ik^tUd he mti iiwtdiy by tkt 
Ups n/ Ikt fngm ai rigfat angles 10 the fm* nuripn. Ihf hand bd£|[ 
fionly but gndukify dG]>rcs9ed in deep expiration and allowed lo rlae 
bggingly and shift iligbtly upwards to meet the de^eetiditig border In 
Empimiion. // Mr hand mwn iAc ivfoa vr frwfA imff/ u^fPtMofiflt 
tti pppQtiU palpAHng hatid Moiu'J En: dJmfvl MMtfMikir m <Af tf|Jk« 
MttgB i9u crfQn or Iwmr Jp U. AUvt rolrrance ta nisbluhed ihp finger 
tips may te tuH much moec freely for ihe deierminaluin of conautcnec 
trd outline. t1 atamt fQin *r Umdfftia$ be tnfounterfd one stmuld 
cote wlieihcT il u SDperficid t&d Felt on lii^l prtnurc. or unl) on deep 

DHUun o» ivn AnnamttAi, oftOuuoH— exakeh^ho^. 


ppcnure vid whether u is dixJiKtly Locdued or dilTuK-. \to4ini:cfing 
or kjaUvic^ faUtnts tan ofim be Rifnlcd nr d^vrnrd by convrmition 
Of bj tfijBctatg ibcir atU&tlon to wme >|>r<iaJ rc^idii wlijch is br^Iiig 
eiplond by Ibe qai hmJ, wSJr *ht tu]>\>i^w\ itn^n porni Upaipoud 
bf Uw oAbcr. /n Mnitf aua noiAnif Jm JAon gMttai atufUkaU 
smfie^s. Tlte dond po«turc u the bcti for Gtocml puqwM* hoi the 
laten] M oAen ot vdoe In ihr [mlpariofi of tht «p1»n nr kidnr^i* or for 
Ibc pujpnei>l''fptl^ff"thcinU*liiiAlconUrt>»rAUrifrhc1tLci] pcnott 
10 niQclir marc ACtrsniblc the lateral region urdrr <-mmipjihon. (A ' 
spedsl proccilun (dipfHOe) i« vrfcircd to umlcr udic^. pa^ 13.) 
Id mvry iiuiBims ibv potieal may wiih advitiloge Iw plac^ upon the 
buidft uh! ki]«o Di in tht^ Lnrr thai jusiliun iu bring 1 gimrib feirvarri 
•KbIb* a ihin ood rdaicd abdomiAoJ wall, the pnved-are bdnjc sddi>m 
iLUmM Qthtfvfv mw uncttr lU^a^dieiLii. FinallyH ali ptrrtiont t*l 
AW ohdl^Mffi ikotttd U Amvuihiy txammtd tmi f^iMni^ tkf Jitmial 

PLICAIIOH. -Poiilla toba DflertniiwL-i*). lAff^Jtiimoj tk4 
iV]^mdrrnfritftufina(v/c, ouilmp. n>ndliionof turfnfp. mohiliiy, i^tl- 
daOC«a>. (b>. rW prtirtV4 i>J sve^tng or htmi^t (intra- or cilm-ib' 
domfoal. riif .otiiUnr. Eurbrr, moibilEty, irnf1rmriM,LiMr>cifiiPiHymjir'^ni). 
(c). Pnstnftrt ^im tt I mi emti i {isMctn fal>c. intcnaitirimdcharaUef. 
exact Iftcalion. fuperfcal i»r 'Wp and th« eir«<l of preoure), Pais 
tnovased en promrt oitlumnly suggrst» JD6omni>itiun. 

Gencnl lupectiML.- Th^ muPTiim. musathtttfe and abdominal 
ouMimf an fttt matfd. iiairrtU dutmiwn may hr dtjr :a lympanlitA, 
osdtca. chrook tubcrcubtu pcntonili:^ ^r^t dilAfai^m ^( ibcAtomach 
or ootoo. pfvgnaihcy cr ovurian iimior. [jtcniiuii fiitirnxum tv rviting 
to Iqnrtcria (pbiDloai Uunw). Ttnlnl hcniu. Hbw:(sa, lurrAiin^Ll obiuui:- 
lion. new jifovrths. dlLatalicm or didpEanratfnE oi Ihe itomiicb, 

(^tfiirrikJ retfiiciioH nuiy indicate cxli^nie einadBliciii , nuvJnorui of 
iba BtOdBacb and especially of ibe cardia. lead poiunmjr- mentnjcilih 
cbmok rtlarrbrra or 4iyv-ntrT>\ Tiu rJtia riAyxbrrvan rmpiinnof ihr 
mculK naDthcma^a, vrphilift <^r akin diMaac*, artah i>f pi^rnlation , 
atn^lij and tb« varoiia hum and fURn^loraEirm^ ulmdy diatiaivd t 
uader Ibc "outward «gna of diKuc.'* or tbc whitE or bluiah Miie< 
iikdk^lsig pmcnt f>r fuA diit«naion by lumar, prtgoaocy, aadfca 
ot rxccwlvc fai; the Hnra nignt ot datk mc<Tian Ime may Jndlcatc a 
prcpiancy, ibc tuf^rfid^i xtuts nay br trlar^rd in the «a9c of pftnal 
or Vfoa csvml olwinnCnn, and pafni If) hrpnirr clrrhruh. inmoricft 







Ttctmii4uc , 


pmlungtd udlca is Ibc fom^r, or Ihc prcjburc of ^xloouiu] 
f^wth* or (brombodft in lh« Itit^ // tkt mptritf cora btPhtntOtd 
ihc diiTction ol the blocHt f\aw in the lup BupcrficU vem (ttm^f 

in orher fnndltlntu ll a tipunrrl. // tiu liaitU dtstmsitm is mtfif amrttd 
in Ok pubic tvriete'Sfgmtn^^ii^IfiKticn hd^v ike litrr u stit£t4$ed^ 
Aoilic abi^runititi ha ^ndiratfil hv mliirKPinrnr wtA jienminmcf of rhr 
c|ngulnc anil lauroal mamillary utcrtca b a clinical ojricaitjr.* 

Viiib1« PtrltMlslfl. — lo iht pifcmcv of nn&daticxi uid i tbio vid 
nluced ^xbmind wall |icniUlCic tmovcmciia may br uotJccalife and 
are KfidHy made ODorr praocnincvd by snapping the surfic* with the 
Angrr na)l or Evri lowcL ipludilrxg upon li a Iflilr nhrr ar appljlng 
the fnnjiic oirpcnt. NomutBy the mwemmtt are dtKhtntk amd vovv' 
IHw and Aom utncSf viAout hflrhary^S. biii in iriiir obatrtHtno thvir 
may «rcm to be Gorcdj aitadLing the atrnoofil region. NonmiJ 
Atomtich perulalsii nru frjm brEl l» ngbl; tha< of the iiuuvcirEc coloo 
from rigbt to ]dt. a paint ili^lly diniinlshcd in value bccntoc of the 
rare rcverud f^mtibU in marked pylofic obcowtioa. In rvktioQ lo 
obsiruL^ion at rhr b^w^l, amtr or rhmnfr. ihf itiKn ft of di«iinct vaduc. 
Qci? of jb commoncfl forma, ttc "la^rtcr pattern'' ptriataUs. ruDiting 
from ib« {lio'CSFta] tfalv« r^^on lowardi mfd-abdomra.f Im tigmpid 
. abttritcliim tlM!rt U incrtsucd violcjJl pcmiolws alfing ihf. roiifsc of 
the colon and a cooiog or loud mmblinjc aModaicd with the dbap- 
' |i(«ranrc or ilMtnKiEUi vhicf ai tlma sharply IocsUm* the |v^l of 
Dorurtriciinfi- Ont ^j Ikt cammtm^l <ataf$ 0/ i w TM M tvinbU ptri^ialsii 
it sUni'tif ifthittUnn aJ tkt xUt^nAfk 

TU£ LIVER-— IfiflptctioniomiiiincsabowsalovicrbOirdeTihadcm 
d««ndingwiih d«p inspiration. The normal fermtsUm ouilia« hare 
ftlroidy been given, (lec pagciaj}. /iMtuAo/fM bof nortJueiavein ibc 
detection of pedloneal Iritlion in milamnatory MoM or abecm and 
I the iiuisi LJtrfiit pA^iIca} mctbotj is falpaHim. 

Pftlpotloil.— ^Tbc nomiai Imt ca/i ofiai be pdpaUd Msily if ihc 
wall be rrlamt snil Th« jiv^r n\f^ mfi by Ihp Iir»gtn Tuiufi vi'fA 
the wall ID deep mapirMioc. Diretl/iat arut itamfdhkutii aj rmnx- 
mmt OM chvaeUrutic of tk* Ihet )s compircd with thai of ih« mova- 

«5ttCon^iuJ hcvi rtslon*. 

tin two wiich in^Uruvi nt^rrvni liy ibf lutbor marfced' 
lo nppeodli^tls ^ibEfii fur a pci bx) uf .^o >^raa. die dIaBMtf «| 
baTvis bfCD mlucnl ii> thiLt uf A it^rK (lUilV In on<c>«f ibvi 
attaehd had bMO w> nolfni ^s ic htrt tfo to ad operation for (all tivncN 
IAm pais bdieg 10 aNBS utcot rvfcmd to ibe b<p«iic region. 



kidrnty ot • pflurlc ^«th And Is lUtrJii onK whrn Hiihralon^ exist 
or \hn9 V dcd'lod limitalioo or complete ab^ncc of iliAphi^pnACic 
Ae^cmi. Any l!i^ckS4^1 nsisiMur in the Hwr Mgtr as palpfltfd indkflUt , 
a niovbid duuigc in the hcpadcliHUc. auch u dntiottb. chronic ongca- ' 
liciii or njswn. RArtt}*. and mctfv ohcn ia ctuldrea. Ab/ iitvr ^iJ;<:f» 
jMrcctf y omJ cx^onsivioiy f fOV t^ivpid reKiir|;(ULu>n hn*^. yri moieuflcn, 
Ibcvr ^ipcu« a k^ammiikd ^nbo ii m due lo s diUicd Hn^ht ^'cnlnclc. 

Psrcusrioo. ^Aa re^nlft prtTUJttioti it ihoold be Bdd Lhat a mJucfif i 
«rra M M^MVdHy tignifi^ant ij it iitvt>ives thengy'mof tk^tefthbenstinA' 
IS FuliM aiTectnl in atrophic dirtiocb. tHmtttutifin of Ihetippfriihor' 
Atx) Afta nLAv aiiac fiom ihriaknge of ihc livtr bul ia mom comoonlj 
oabr apparent and due to anphyicntji oi the lung or, nirdy. diftphng- 
GoaiJc Ijciiu- Tbi!» tzn vacieawjllidvrpiniqHralion aodTApiL«Ll>:in nf>i 
QO.)y b> rtuon laf Uic cVicvnt ai th(-«T|ED0 bul because of the dccccat of 
Ihe liMig bonkr. JwcWiatory p<Tciu3ir>n will bp foiuid vaduabLr par- 
tjcululr in cooQcctioA irith ihc kh lobr or m deddiog whether 4 tumor 
la bcpaUc In origin or atutdioiftit. The sicihctfaqse Aould be pUced 
over t^eil>ur3£K 4m i4 ntptffidiU heijoiii. du.l£ic»ttliilei1ieriRtrerUp» 
lb* tiirfan in tadiating Lines until Iha dfdded change of note indicaict 
lluJ hqjoiic itAiie bas btea paaaerL AlUuliud lun^on uUl usually ytdd 
the hepatic note xinder iheae condrllisiu. On< o^ th« ^^rmmHMvl frr^rr of 
the tjrro in The aajnioatlnn cf the Mxtt or vplern t< thjii of beginning 
palfMion loo higb* jiTcal cnlaigoncnt of either citkdju bdnfl frcquccily 

C4Xicllulou.--l/^w0ni cjtMHiivit <4 dulnt?fl in fJtf licpatk ^riv sug- 
g««>4«bLrgfaMfll of Iht Hvvr, plmiral tfluaion cr arlhmcrtb^ puUnonafy 
ro—otiifalhai. bepcOlc or mbi^irrnit: absctsB Dimradicti t/l upper 
katmivia indioiEeG hcfiaticr ajrophr« adhmn. emphrwinai pnru- 
■uxAffwc^ g&ttmu disteruic-n of a ntbpkimk abKrA. hrpaiii: proais 
ftiid tvcly. mmuvc pericardial efTmiun of csfdlac <lilalatioii- CtyKrul 
fw^glfmtnl may be due to patthv congr^iion of cardUr origin, th« 
conaonott tauuc bypaiio^bic cirrhusvL Icukaitiiiap fjiUy \iyvi. htn^yluid 
JiilMi> typkBit, atbfxr. guAuna, ibicaii, pyemia, Cm/nU tkritka^ 
VMgff^n aiTDphk curhcaaL (he cenmionnil canac with acute yellow 
abophy u a dinjcaJ osriosky, 

IrreEidmritiM in ODmne.--Sudi may be due in rongmltal ikflMt& 
vancus t:iiUrgenicnUi and dliplaccxDcnU^ atrophic nrrhosb and hulced 
practically ai] of ibr cnndiTiona noted in ft prvcrdlnp psnigraph Of 
apodal BTjcailicaDc;* axe the nodular incgulanttCB (often sliowInK. 
cntctiloTB depeaaona> attociaced with aeconckry cudiustmik. %a&\ 

I Aniitii> 




itrDir^iL ikiiuiimnit^ 








I MrtiftTy Bn>hUi4, Ulksntian Hrrhotu mfty prmlvcv nu^rkcd ahrintufe 

j md dtfJdnilTljr whrrvu llv tiny grnrutir cinniions of attfipkif eirrkait 

<MJa be p«l|alod onl/ under cnccpLi-^nnJ <ondiliC'R». aa when \h< 

ii Ibm and luc. though Ihr sharp rtusUnt idf^t in nn ddMiicA^ 

Mn luuaUj due to ft <ii«tCQd*d i^-bMdtft >bacna or h^xlatul cyM; 
lTip IbbI jrlrlLUng ■ prtniliju^y ev|ukiii? iWi\l nhoing iht pemndoD 
flfii>kc. It shiHJd he nmmhnd Iftjl *» niori^ed tiwr, Mxty p^paU^ 
uith a smoolfi hard twfoet, ntggesls amyioid dta^se. /«iiAv arngtOim 
jfKJ jaUy fntr, f^**vttktnmg ntzgati drrhasU m- Ite^mmAj^'f; n^ulaihm. 
carei/tome and ayfktUi. himMy it will be noi«d thai mvfT jikttam 
jr ^limumliuii av Uic IjituIji: am yicltla [lu iiifoniMliuu ju to tbe utiul 
wie of Ibc ofgan unl«s tbcck«<f (onrfiilly by ad exaininaCioA ot ibt 
conllgiums iutiiiur«. 

THE GALL BLADDER. —PalpMbk vdy vben diiutujrd tl msj lUn 
I lonn JL [)rur-tfc:ij>('d ruTnor.* unoolh iitd clutlc. aiichoicd above but tnttj 
mtvMt inasi aide lo lidc. uxl in the pbtfcocc oJ ulhcBioiut. luin^ and 
(aIUilg In nspinioi^ rtiythoi ?g^ Hu Ut/tr ila^f, lUrely* a poJpabk 
fTFiiiutkin taay be nbinincd if gaH KLono nn? prrvfil ar h tnny he 
ooduior fn>m mnljicnanl dbcoK, In lonj; nlandinjc cbo1ocyUiti» \t may 
tmder]^ !4irr-phy, 

THE SPLEEIT* -A grc4tLy enlar^il splccc uid more nrclj oat 

icarct-ly mcjr ili;in p^pabl* ffuy b« btto lo moi'^ vrib Ihf rapinlioo; 

fucihf naurr, in any i^av of j^pkDotnvKoljp n moikccl ^(vminoKr cpf m kjul 

the left upper quadmnt i« produ^cd-t A« in Ibe cue cf the liver, 

, Okiaittafim mxj tevnal Trictinn uuiidft In the pnvjicr of pcrisplctibh, 

or the oTypc m^ be Anchored by ftdhmion, bm ii ii crdim*riXy fffdy 

i;fuf tUrtttly iHMdlJIr v/iJjj f/-rj>iAiri^. jjrj'i ^fniti/m is Hu tmiy mtik^ 

, ykidi^( I'ffi/tftoil rmifi. Tbc poulion of tbc patient Bbould be ngbl 

jUAmlU minor eDlargnnenUaTclQbffnolKl^uin typhoid fntr or olbrf 

I waits infcciioos. and ttte H^hl hand sbrrutd nuULf piesoiuie pcoterkdj 

while Ihc kit niAko pdpatian. Abdaminal di£tenMo«i dcfcoti pd- 

f>ii|li>n uw In grrai eivbr;^meni and ihi njrmaJ i/Jicmi Ji Hdf paifaMt 

*Thnr tunHjn io lare trutttntm &ttun on csunow tbc Albunn DonxL 
liAvliu mcTLilT jeponcd ocic sJunAitfiiij; ffVorAnt f^if. (Driliit Mtdk^l 
Jouni»l, JaoG 17, 1903-) 

t In A <u« nceailv ahnn by ilia ouibw to the U[ui«»atii Sute SocuEy 
> ieukcmk ipUciD filled Iha eotin abdonw^^ kctiully naching fh« ri|hi 
■etfrior tupmjf nailtt of Oid iffunt, Kfid iTruig' to uj thn {uiEirni showt^ 
ne Unpalmimi of nnlih. chansF in color, or roAlnuthrioi »nH dcdLDed to 
tmat veffc ot uke tnatmeiiL 

trmKAsm or tvb irtSKir. mwinn. 



// grtaUy miargrd ifcr detstd ^iiiiyn t.i f^ fr/ prrjftfi-it nnH vht* ropHiiinn ' 
GUI btfilty be omtookc^, urLcm wiiti n imxc w«Il the cArdoo or hurried 
***—*■** bli lo gM bdow Ibe «rtuAJ bordrr or to <tititn|^iiih bctnecn 
cauKokr rraiAsn<c orr (lie <]nc aide uii] ihc s^jkuii iniuji on ibf (Oilier 
In thnv casn th« ekuf mo^H in the Antrhor border ift ahirplj f|»5T)«d 
UmI qwlV tfiOnttivc. Slvilenis ■■ fint palpelf iotr tU^pty \n tvijoit^xv/v 
minor cnkiscmciit In off fcnrj vketc doubt nrhn js to Ihc nafure 
^ m tir^ fttffcr m l*# tplntit Jtrm U iM^uld he rffnrmhrrrd thai a \plfn\i 
gmrfh cr Inbhv u tuprri&iiiti, thot ih ditlnrxi ii marked and e^in Ar 
<arn*d ^irt^Uj iak fi> at ntvmai tirra bthtntl fhr ^JA. %oXk itnd \ith 
rAi. Ik«t a i miim rUy ama dirttliy uith rtsfirttiim and thjtf if fA« 
cd^ hr inffai/J i^Jlmcr ttrm^ dalrttss it not impaired. <)a (hr con 
inuy. hrgr rawi lumofs meru] mcirr ilnply. xrc irlilivH)' futii or 
iimmovdblci lU^ ULcly lo be rcntfnrm or noduUi nnd brr croiiftcd by nxi 
u«a of rtwnftnnt K (hf cnlnn faf disltTiflrcl wtih air An iti ihc (lup of 
Ibe Irwr « downwAnl dbpliojncat of ihc <li&phnKm ixia> produce , 
am ippanni lacrcua is IM lover epleiiic am just u an tmph jhaiaious 
luog or a pncumofbiiiiix maj oiuac nn npporrDl iliminuiian tn its tipper 

pCfdVOn ATM- 

C«03N3 of Ealmrcemont,— KnrenAv (Afi^n^ rvifVj^nnrKr Fs mrwi i 
fatillKxitljr due IQ lcuk»n», ftplcriic ■TumU vT chnrnk ni«ltrn , Inv^t 
dlfMU ma^ be in«l wiih in cirrhiMte of tlif l^vrr, rirlcru. ivmiriikui 
Hirma. t*^^ oongotioa uc aciuoI porrol obatnatHML Aft4lt\ 
ttUargtmmi k mod oflen ^countrrcd in *cf>tiGEniiL maUnol Icmr, , 
lfpbc«d and ijjihui. n^^ipdju. uniic milUry lutirmikBu. tubrrruloiu | 
pcri^plti9v ccrc-bro flpiuil mmmjcitift }imjiIl]»<H dtpKthcriii, sfarki | 
tfvrr. TvUf^mn]; irvrt. in/nffi, jiln^ir Ani\ ivnain nth^r Trfipiral divfisr^ i 

fintarjtnitCBf af ihe jfU^n ii neatly ttiuityj vni/^rm. tiht<rSJ ^'"jT «" I 
Mt4tti>ruti, attd hydatidi ffr iart:i^fima an txxastvdy ran comm ^f irrrg- 1 

KIDHEVS-— The tiorniAj kidney yield* no f»>ult» to m*portii>ti or 
tuifuluiiim And inir^njlr nn« m prrnii^ion When rtiUiTml hy diii- 
c*ae il maj be cndcni In (he antrn'tir fumbur region knd hic tt&dil]^ i 
srrrMdhlf Tn pnruiKinn tnd pklparion Jin-i, buJj^in^ may ahn br msni- 
le<l pctfrricvriy. The nrcoanala b cbUdrra, and cysb'c, tuberculous or i 
fc ydjoqihfotic kidney* di lb* aduJl. ue tfae most frvo^uent <iiuiee of | 
cntujciiMiiL I 

PllpAboB.— The dorul nnd semid&nsil poiturr* ftti; the bc<1. and, , Puiiurt, 
jn the laKer. rp^uiicin in ittniiUrit by hiippnrtiii^ thf^ hlinuldeiK and \ 
bvHocki and biiDj^s Ihc hand and onn of the vAt >Aiiet v^cvn^AA&»^\ 





icchiitiiuv. obliftuely di»tfn#8rJ and font'&rd anufi the tbdoocn. One 
oEtbcniAnuncr mAkfspRBeuitovarllif 9oihliDj;ribeof i«9t b«low 
poftrrioriy. whiJr iht oth«r U pnoed iSftpij downwanl and 
upw&rd i>u;udc ibc rectus borda od a levd vriih Ihc onbalii 
fii< tadmy U metvttU it vill dip dovmwud in d«qi uu^ndoa *o 
be leruapoi bctwccJi llic tit« uf Utc finjenv of ihc ln> b«id>« Tic 
nitrmd/ kidney ytUU A> palfciian otUy ^ tj t mr Acndlfr «uf JMf mIJ 
<imJ<r /tfViTi;^ ftfwJt^'nj. .Iivjr pfiotff dtgret of Hu6£tt^ tinulifidcj 
f ttwpobk kidney^ If tlu <vgut b *o movabU vid dbpbnmble «s t» 
r vijgp$t a RVMnephron tl i» a /feofing Mrfiw^ and mrh ant ncnetUMS 
ovcriookcd becaiuc dl the moment thcj' occupy tome ilislout potlfoo of 
Ibc abdomen* being frequently found lav dova in Ibc tegioo of ibt 
pclvJL briui i>r dia^accd miuw tfic lucdiuu line* 

P«rtusUon<— Thv •rmidontl poailiofl i» bwt idapltd for p«rc««- 

sii>n whirh is usually sufirTfluoiu^ unfcftain and often nialiadlftB. 

I OccAoIoaaUy dispbuxmrnt is t^Mgge^lxd by the sdbAtilotkm of lyrnpany 

I for noimal duJnoR or an unusual ntctwon of the laiii^r may peAni to 

I diacawd contUtlooa. 

Cbaractarlatic FMtuns.— The ntaionn «bape Mid pcmhar coo- 
viiiicnL-t^ [jf Ihr kidni7 lue ivndily itoi^niacil «nilon the orpa bt- m 
innamvd or the se^t of a new growth. Under tbon condilloTU UU 
CvvKif is rtadily falpabU. t^UoivHy mf atiftliMly fhi^ rtgttiar or ifftg»- 
faf> tmoiflh Of nviitJitkd, Oi^ordmji l9 fht ttnUire *>} Iht marliJ ^ih^». 
tf th* itrgam fit mfffty fHtKVjblf as u tu cjttia tk^ eua. Us maximum dkii- 
fiUttmfni iKtjtri a^ar lU avt ^j jnU tKipiroH-^n^ a (act rca<lily ciptaiQcd 
by lu ivLatioa to the diaphragra and tha dircvity inoval>lr iplcoo and 
|jvcT> Furlh/rmirre. Mtch disfkoiat kidneys an nfUmMt imta lA« 
fhnh «f norrml kidney ^»Tion and in fix«d mMl htmtn mficthm ^j 
tk4 tolon titiiftlirhfi a band aj rr£tvumee cfOidng or wluHy tdsamimg 
Ik4 pertmiion duifXis ankricrly. Srewdory aiutji in At rat^ n^ imt 
U nol uncammfM at n sequence of nvgka^d afi;>rTidIceat a baom, 
cjSDpyrnia. -lubdiaphrci^imii: uhaccaa. i^arkn of Uic ^-nlcbra. ric. and 
one eaatt consider tht- ght>titar tlistic of fpuih4y fiMiu^ting tvaturt 
of hydro or pyoncpliroitis, the ifngiUar cyUk IttmorK the <ktner wMart 
ncd*ii4r nhjHi^ianl /^r^'U^lhs aod the h^i^^iitas or MdNniMtfH of the peri 
nephTflk KUppuTHilanK whlrii tend posUriarly rithrr than amt^rtorty, 

*I1 is lAinrtimn a4tiMd that «nniinaiion fchauld ht m4<!' vriih iha 
patlrai Inalng fonard in fhe iiaiidEns peMun mzh [he rlb-iAn or Funds 
nuppnflriil tKi > rhair or UibJir. Tlw aumor haa nrvrr Iiiund thih pnxAlore 
of 9)4(tiiil I'slue uo^iJi 4lLh citnordhMrily lai abdamcJutv whi-ri ihc kid- 
ney VAs grcAlly cnl&TfcI' 

PiseAflfia or ntx iT<m*cv. 


tindlrtiaclion to nixtiovi of itic kidney itielf, Cbaiiic antl 
tnkfOACOpfpC vtnntlDfltion of Ihe urlnr, rarvful contidcnttfnn ai iinmarj 
iaiiton ami ihc uk uf (he ifpiidiiiii; uc«dk unuA tUagcoeu. 

THE $TOUACH.-f^«s«nl Q)fi«i4*mi^afl.— D<^t« ja<ykm 
4ic|i«Bcc ibcn b a ituurkabk lack of poNlire knctirledge In legird to , 
Ibe a^mdly. diBitTiiiaru and rormoJ po^iioa of ilie biimaa ilonaach* 
Mid. Mf«(l. of ihp vjiguin cf in vcrrtory Aafvilics. The iiomsifh of 
ihc nevbom baby bu ft <tp«cily vf but one or one and a half uuncca, 
yrt In bam >ix to d^t yMn Uiifl U incnai«d to «n« quart and iha 
<a|MdiT of the adutt »tamacK > anea tiom one to two qtuviSi Fnv- 1 
0/ ihf jjMnofA /i/j ftf fA^ Ufi /fj ths mnfiufl /■"'; Ibo livuvcm ' 
il Tnria frum :wdvp la idtlefti inchra; the dqitti from 
alwre donmrd U but six inches nnd ik<diiijiia bchtrm tk< ^yiifkanti 
tariUc tfH^tf ftuf ^ne ^nJ d kolj inchts. Thf Jimtttu lift in tkt trfi tup 
of At dicfhraxm and ihe \Jp\ncr limif of pcn-UAsi'jri rt»>rmri<e (i-jrtiuJIy . 
rAradli 10 thr f^llh Icrfi jRUrtftacf in Iht farj^ttrnuL »n(1 miiV^iLvic'ular I 
Imca, iibile the lowec juak fmcn oar lo tno indici strove: Lhc uaicL ' 

/■an af ihe tnni af tki xipktid, IV tof^ac oHfUt lying alout aa in/A 
amd a kal} Ic tJtt Ujiy appotiU ihe 1 %tk iorsftl \yrUhm'n. Ah»oJuic line* | 
cannot be dnvn fnr the deljininjitlon of an nr^n to dUi*tiflIh1c and I 
frrcJy morabk. In ^T"cral il nut- 1>« aaid that a !»lo(nadi nhcee hivrf 
bonSef irachc* \hi> iiu^^l is libnDrrniLr ciTber it\ iitf or |x>»licin 

PHYSICAL EXAMINATIOH.— luipettion — Thij )idib valu' 
abir rviuJts morr oflcj^ than b j^ncnJly .luppoacd, and. especially in 
OMK «fcb tlifn, rrlaird, ithdomlnA] wnllE. thr mitllnr nf n ctJKtmtled 
atoraacb flnay be dearly ddtncd- Gr^vrthss ea^iedolly of [he pylorxM, 
aw often wen 10 move wfth iwpiratlrin ard normal (l^ft t<i rig^f) or ■ 
^Txy nutlj fcvcTwd (ri^t to tcfO pcriBtaJsib omj be prtseni, often , 
aSording valuable coooborati^^ nidence of pyloric obtlruction, ibc | 
gaunt wans bcJng Ucge ami dclibctale and taking from ( In 1 Eniaute ' 
bO pcua ncTon the field. In the fonj^cniTal pylonc i^balnictifinj of chil 
rircn the Rimar fK often rmdlly iveti. ^ 

FlitOfOMOpy and TruufUnaaJfifttioD.— fiy jci^injc the palfcpt I 
Dianfvc deaea of btunutli «ubnitraip (39 gni9.) mije'l wiih porri^ige or I 
ncna amuliT food. duoroMopk or skiogmphic evidence may bt ob- ' 
iBUied. vhde occaiJonaHy £infaoni'« tncibod of trajiKillununallon may 
fscatly auiu liuptcliinn- The giutriMipkiuu h merely a modcnleZy 
rijEJd bougtc or loft ivbc carrying an dcdric licht. The juilicni diinki 
twn ^tmm or morr of waier. after whirh the intinimpni U \T\\tTAae«^ 













%nd the drctric Gbnjit aom^hiitd^ la a nornial itoniadi an mumfanBl 
tone %ppevt in the rcjjoci of the left tovrv* legmtnl of tbc nofnul 
funditft And crioidA About (o Ihr Inircf mftri^ of tbt kft lunji Tr b 
uiiuixul&r ta futuit tfic a^k^ bcin^ downwtnl and ilisbd}r itiovv tht 
unabi&cua. Il ti*lunJly lolJowt Uutf in ^tfOoptedl or diUlod ctdnud) 
(gumaudft) tbc iUuniinAicd un b Itiwer and I^r^. Tbc Mat' 
RiAtum ffunnl ihfoitgh mflaljan of llie piocnfrch a unally 90 inudi 
fptaUT difLt ihr mrtbod it sMmb nqaoftl. 
PiJpttlon. Tfti* ts chidlj u*mI to ddcnainc ikicc point*: (1). Tif 

l(> ^ n jJi' ti) tk4 mt4uin Urof bttnvftt ikr mtirgin <^* iht rih9 iifcii n , 
(tmj lA^ mn'd brJou'- Ami-% uf ihicknung, ufim pUqut^ likr In fed uj 
Ifldlcftlc Ml old ulcer bpac aind Ibou^h udhniocu ficqiienllf 
MnchoHnjE ihc tinmAch (fl adjomt nripni and gnnllT conpH 
tnd ubamtinK dfaienoais. orJintii^y lucfa ien>w|lM move frvdj and 
iodevd oltvntfrnM uv to vfclrly Tvimwcd fntm the tiiiul sttic m to ng- 
gnt gnwIliA uf Jifttint orffank. TAn'r nuTVfm€nl <mi pni$itm in £fffi* 
MdtfM vt'A injijUim tktn bx^mM of tspf^iiil mportanf^. Ib wijr !&■ 
flihbp abdnnipni nnr miun be m hi* gukni n^nit TnUr^ildDgodieriDvr- 
luna, perbapa normtL for JC»«tr^c ijowlhj. TnterMilknt Mnudk rifi^ 
iiy over rhc- Tun^UA m^y bt «rcoupierr<i in ntt* of pyloric Mfneab and 
llmu^ (rlunl Uun wolbor jh taacsof mtcrvplaw Ulc pxbrvsmjbe 
dutcll; pAlpaL«I and Ml to banlen nnd nlaii wkh ic uvodaicd "«qiiiv1- 
jng" t€T\»iUon (itpritt ir^auuh) tad. if iKifi tube be lunl the point mty 

, be dblinctfy (cIl ut if i* cuAxcd DJoog the fower border to the pjlorw. 

, Suentxtiim U nbralnrd hy fiUrEnf^ one hand nvrr tbr L)ff«T Irfl rfht 
poolcrjorly whJc mAkir>K ^ntp djppinj; morcTnenU anteriorly. Any 
tpEuhing lountl »it^;^l« djlafaiion gr gKUoplcais 1/ r/ iv/iirr mflrt 
iJbfn 7 AiMirj nj^ a mcaL The falue of ibb aign hu bcm gieoiljr 
ovef««tiniDlcil and is pmdic&Uy Usiitcri to iu iKCuneoce before break- 

, fi4l or 00 a fostJnit MomuJi. /n ixftftal H mtrriy mdicalu aUgki 
mokif m$mgkuH€y, or. jf it be otrtnmca wiihin narrDWcr bntet but bj 

\vay sfndf Uipfhtg H iMotii'ty >ttgf;ftt$ gtulHc al/nty * Klnallr dHa- 
iciint cj ti» iiirmach may, thj/ni^h nrriy^ ocew wlhtntt tuperftMi sphjJt- 
ta^ amt the rign » imdoMftSiy in KMm tUgtrv tItpfmitKl tipim tkt tim- 
iltlnm oj th€ abthmimii s-uif iisr//, 

PvrcusdoD. —Ordinary percununn te of Itritc use tnd need not be 

dUcusKd- It VAA fonftcrtjr ibe oiAom 1l> iiiirixlLicc a jKni or more of 

«S«bIi diHJDftuUia bdiitai **4(e|i ipbuh^' ind '^HipcfidaJ ipluUns." 


wAlcr Bod pcnruu tbe ^ull urs iirviiucol. bitt both the boundai? and 
the muidr looe in brtf«r fKlihiish^^:! bv inflAliur}. 

AuicdUtury peccusuun a i!u-tinctJ>- uvful. panicularlj if prc' Berf 
cedc^ bj^ iitdaEion. Normal jcucnc tympaay a rcprvsicatcfl by tfac ^g 
mvtil of ft drrlr. brlc|f llmllM) above hy hrparlc dulivu. bitt Indurlrs 
Tnubc'a ipttcc adJ bu a mrved border hrhw which jAmJ^ n>ff rvii^A \n*t, 
ih« aMMl> Thtu contraction of rh* IHt k-hr <»f ihp [ivi>r, iUriTtliap* 
of tlw \th lna% an<1 jnaiVcd diatcfiuoc ^r the Alumacti tfniJ tu ctibrKC 
fL Bj ojeful auKuIUtary pcrcu-emn Ifac- uppo right incl l«fl lizmij 
nny be smewhAt moidrd. though the chjuigi^ of note due La the lung 
ftnd Uh ht%*lk lohc vil! be (fininctly omriicdL 

TRcbctqne. -Tk^ Ml i<^ ikf U^h^acapr it plaud fust bdotr ami h 
ih^trft ijj l^eniifimn ^.trliij/-r 4nJ ptrcwwn itf csntrd (rom U in m\\- 
>ling ]in^4. fn trconbncv with the bounclarin outlin^iJ aUrvc. t^ith^r 
fnrai ihc -tcthoMDpe vutwrnd ontB the Date cBvigcs. or. Erom th« 
futnounduig Df|p|jve uvac EowinU (hftt of gutric imonance. It it 
wkH |£) 9ih[fl Uic prAiiLr:in of Oxc stelhaKnpc vid repeal chr |wrcu«icm 
tnonfct ittdicdc rcvulti. SoaIho in tbt ci«cuf 4 j^}w(h,tf the sictho- 
■enpt ht pbirrd ovrr h tf^fl n ^nilbr mtlhod fmployivl, i^n^ rnny iiUt-n 
ddcmunc it» oonncrtimi with !bc Blomach. An dabomtt dcsciiption 
of Ikf loacA it unoeooMry u thr vtrisl tyro cxn distinguiib th« Khungrd 
mieU llttt indicstei lliftt the alnmndi bandd hci» been pa»cd,* 

AtiACttftitiOii-— ThuRhvoAvduekM method ^ndxilsonlyiuc in (he ' 

Already rderred lo, ojid the <&nl£pje or huin^ of active fermcnution * 
mrt thr if« for h^iir Rit«t (hnfmdir) ^romnrh i 

Ttxrck's Gyromcle. -This inUrrstia^ IiuEnjmeni kcda iladf 1o | 
inqwctian. palpal it^ kn J aiuniJtiUciii ant I cunsiiti of a flvxibhf plvcp of 
ited lod) aj a piano wiir indoieii withiu a rubbci tube and besdng ofioa 
a soil cpackfle. Being Introduced urrlo Ibc itomaeh it b; attached toa ^** ' 
tlttk hand Enfttmmcnl mhlzh oum* rapid revolutkina and will daLlnciiy 
•howihcq>onjcea«!i pftAftcaatonjr the lower jpuiricbonlcr, lu inventor 
uwA ft nnt <^]j' ^i^r dinjcnn^ie liur for thfrapnilTc purpoaM. 

InflfttiMiof CboStooiach. -J/<«Mf. (r). The oldest utd Amplest om 
involm the administration of une dnun of aodium bu!vrbanate in a ""^'^' 
wiM^flsfullof ■aler. /ti/^fruvif prompdybyaacqualiuiuAJDlof lanoric 
Mid nmalarij diaaohrd ThrorekiiaUy it ii open to Ibc cbjcctlnn that 

*The note b unlfenn in qiuJEty and pltdi *u tonff u (he jMim'A u per- 
fiiitfd, ihouib ialnafeiy dcpcnib upm Ihe <li>ianoe of tho stroke from ^^ ',, 


iccnpCAt iMAGivoais. 




■nil 1^1 it « 

•uiout danjicf m*y fcnik, ^pemUj in ulctr. (mm owntoemfaaj 
ptaOkfi^y (lib d&n^u b ril^l yH the meih(»4l a tkiidodly blerinr Ba 
lliG loTJowing on«. Ci], Aittr blroducinjc tfa« >lomAch lubc^ «ir b puaap^A 
into Che f|i>mach wilh a On-idvtr'i ><vnngr r>r if Oir jMtbml bt idt C tfl 
tad the physickn count^ou^ the m^LiciQ may be spcoonpGsbfd bj 
blowing into Ihc tub^. Ai 'he d^grre of inllacion b wholly uwIct 
ooQLful in ihb mtitcr itic procedure bos Almost vholl^r ivpcrccdcd die 
older one. The dbiensioa «bouId riot be grrat i^d ikc tfune cooM- 
intticaijcma (jnvcm il u in ifac uk of ibe atonuch tube lurlf * 

infiaiitm brmgr iRlt pronmtmtt lunuvj <»/ M# dfifffTtfr mUf and 
f^frwtf/^i iAojf ff/ (Af pastrrUfr \raU In ^m<rAl. z^^^ g^niKiht *rt 

iDterprelation of Outlbie.— The nomol boiunfJAriet luve tlrcftdjr 
been itiv^Ei; if utii]i>ivnAl. ooe should caicFuUt TKite whether ihtn ii 
merely a fiitrmot or ^firmmaltiy turmal tvcj in jif tf^jumo/ f^hivm 
(^WroiTUub). whrtlH-i Ihrrr ift Wh afrawmi*/ podium ij«J jHerMMrf 
OPM (gBdtropIosb with crtaaiA), or Gnally, nhelbttr there b gmtrtl 
mtarganfiUviilMtml marM diifJanttafiti <<iitnp1e 'IJniition). 

soft riibl'Cr tu^ conyinx ^^|>tc trnrfiintlifirL^ %t lis cxlmnity and m 
Ur^ lerminil i^tfuruiJoiL Ii sl^uuIJ be lUTRiauitlrl \rj a f^ua 
funnel 4fld «ome phypicions inlrocluet, a fuw Inchei bdow, i ^n 
lube » an inrlicMor. AocnnHng lf> llir aulhor^ nprriMOP the liDpIrr 
the siomoch tube tKc better Arc the lesulu nod the cbboimte md 

Cootr«liidUttloiU.*-V&dcx cntBin oondiibna ihc Inlnnluctkin of the 
tub« ii unjujftitiabb Ud dangteow. an4 It b alwa^ necMUiy to bal* 
ance the irtlue of the nault to be obtAi^icU imd the jnaaiblc dugrr 
eiiperieDced^t The following MQJitiona ttsuaUy larbid the tiae d 

I th^ tube Iff lAf>sr fuif kabitu/Hfd In iff mf («). Exiffmt uvaliitfst 

I Rtiad JJJHwaifiirjjfi fif Ij/rjr fJiWc. (d). ,4ifi«ntfririf jriffw.tfjrm^t or 
I piJif rrrv&ro/ hfmrrrr&Oftf. (e). ibvfVMiRfjr. (f). iitorltc «>tf«rbT». (g). 
i ]'«TFnit«i pulmtmary htbtrcvhtit cvpreully if hirnvfitytb hai occurrrd, 
1 00' Hiz^igrndti ojmpkyitiHij. Furtlwnnorc. in elderly penKHisof jipo- 
pledic build and tendency die Gnt pa**ffe of iht lube usually inrolvc* 

* CoiticIdriU dHtctiiUDii flf iW c4aa hf itijtdi<JfL« uf wAter b cca^jtoyrd 
by »crTDc eliakiBfij. 

f llwt ibu (1 n4>t inu^iULiy utM tliowix not long i^acc ia a eu« obMrri4 
liy thp n»thnT in whidi * Xtr^ t'Jt tabt foiwd dirwtly tkrew^ tlhf bM« of 
e. ur<t*ioiiia(0iii ulctf 

KXJMBi^ncm ot OiWmc coKrswn. 

tfi ttnooit of ttrtintniE aod con|p«ifor that U rxtTttiif 1y dangprdiu. , 
ThtK rcttriaicnt nad *^y o^ply !*> htmarth^xU uats tatd txntitarism In \ 
tkM9 Mchimsied la th4 Mir ej th* Subf. 

Tec^oi^w of Intioductimi.—Tht patiVni shuulO be rraAurrd and 
loU bo obey orders abniubely. cwalio^in^ whtn told to doTuand brrftth 
^^u <kvfJy Ibmugh Uic aosc Shafp tommandt are oUen Kurc-acrful 
^^^B clTeclire in ahulUBjc o0 ncncui |?tKpn]E or rcichJnjE <*r aiif mpu 
^^fcuU ouBt iht toht, vMcM skMdd bi tutrmAf t>y p1«dng il in hoi v«icr 
^^^fi Hht a ^ aW infrxHfNfnJ promptly md firmly ifttlliobl btutc nn^ 
willioul Rg&rH 10 (vmponT}' obstructJort. Th« palifnt may b? ukrd 
to ivnlkiw as h rc3u:h;s the phiuynx jui<l ihrrv nrcd b« litlEv hni that 
ta wiUwicrttc larynx; if it docs, the fact 19 ilI once evident, ttc Ivbeu 
T i mot et l and no hann donp- No caimdtriMt farce U at 4ny timr 
■Oiniiirp n^ ihffuld k U emphfoi. The depth rt? which ^t ^ould 
normattjr br p&ud U iron t6 to ^9 In^hc* from thi- tnnn and the 
ftTcrfKt distance a usuulLy indicated v|Kin the lube, Iti ccLuia it will 
■Kd to be mon rfveply iniroductd »nd The fiiot j« disgnoiFJctUy flug- 
jEHtlir, The paiimt^ b«d ihoukl be xJjghtljr formrd. tht moufh 
opcfi, iA« li>ii£»ff »tf, and ihM^ in the irtlnditaim «/ a tiom^ilt lube 
tur in fAol o} an emphagal buui^ u fJtrr? fAi? il!£hiat rfajm far inlm- 
jMcirtf M« ;(nie<r JnA> tht palitKi't nutuih, a prxedtirc which incrcucs 
pifgmg and diMJttt and ofien invnlvM a bitten digit, To otjfjin ikf 
t^Menis. the palEoil ii naked 1c taLc a drcp braUh and slTzim u ai atool, 
vfailc Ic*ning vbaTfJy li>rw*rA Thi* mov«n«nt iniy be ouisicd by 
Arm jwcEn^rr o«rf ihc Tegloncf the nA^-cJ mnde dlhrr Sy thr palirtn rttihe 
operatof- In t<une caje» il may be neccjoory Ei> attach « nyrinjtc bulb 
or Pnlbur'i bag to ibi* lubc anri make %ucl\on.* From ilmr to iiinp 
a rubf mty be blocked and the bulb tony be uMud to hnx in jda of air 
or. th« obMnKtJoo may dinppe«t if ibe lulic be tligliily wiiharau^'n 
i»d leinlttjducnlj thb Ibltct pnHcJure bdng often nrctvaiy In any 
tfl/tAL Iki fifti otlfmptt lo introduce a vtomadi tobe are usually 
aaaociated wiih more or Icm dolcnl retching and irraining .ind aie 
j-rcaJy djc4w3cd by the patients, but ihey may be assured thai after 
thnt or four fntTMfunlotiR rbr diunrnrort vrtll be flight. 

EXAMINATlOrf OF GASTEIC C01fTEBTS,-A*itk from the 
hwIImmU 'ii^cnl'?*] uH'kT f-^4Tiinaiifiri of the ab(k>Tnea. rur kncnvlrdge 
of gaalftc ailacnt^ dqienda upon a toiiajJeiatioa of tbe gmt hlatoiy id , 

*Sucti a bulb mn readUy Ik &tieil villi ■ kIka la^jr thai mvLirnirly fiii« 
ihr <aUlKc of Uw nomadi tube and the dcnoc ta beati than the uk o( a 1 
bg^b on tbc luU ladL '' 



K«tp fin' 

«rr ■ Uitl of 


4il riftltnlK 





f Avalitt^ 

Ktttct ol 

connvftion wUh a chrmfcAl rxftnduik* otf lb« WDOiaah coatmii tikn 
Alter ■ icM moU- Aflu ingratioa of aajr ovdinvr artkk» of food iben 
lolkiwa • prrod of rmng aodity. The hjrtkochlock add comtiiDeft 
pininptlT v^ili the pmifidi uid aBalint bvo IcBving no frvc adik lo 
inhibli fcrmf nUtion by b«cicm, heact iar Iiwd ^5 to 40 mioiim tXkr 
« mral rmr n^uld find hyrlmchlorir nrkl Ahundjiiir fn cnonblQaHen. 
bvi Alncni u • irtt ndd, wh£l« ittrch inmfonxialmft *ould pm^nw 
wiJiladtml tod bctic Kid would ippnr l>«cau» of ffmaimtkn «r 
mLnductloo vhh ihc food. A ficcoacl pcnud fbUow^ dunEig which the 
aAnitki of U>c pmlriile «it vatUficd, /rrr hydnxhlonc add feppcut 
vid fmncnlstlon crucx vljiev cerfain ia( maitj, Ihit prhud ik»uU bt 
aJhimtd en kaur afUr tka vMif m npal^d and <me tJiin Uaj 4 4<fimk 
ntfmol hy ^kith ivhnonniil variMlfnrui niAj hr mra^irtt- Th£a flfconii 
pciixl iV /n'^oipfd in lira ikimrT or mart by a third chuactcriscd bj a 
/of/ in the icidilr. An rxtttt al ftettidt rr^wri miuh cfiJ }^ cpwt- 
hmakpH amd meani in jU ca:<s a *i^y in ike apf€^tH<e of /m hydro- 
tkioHc Mid; an atfu oj tarhokydtGits AfA h t»t cfft^nk woj. Ikcir 
«<ld aAnttica btr'irt^ giramjjd)' utbJJciL 

Pobto to b« DcCtrmlned, PriA^vily one «R:kB for lrm§f^mh 
Mud hydrnrkljirk add. ihe i«iier rrprwnting a lomc (tomial CDOfei 
bioBliOD wilh iJiali^buEnin nnd undergiUDg progir^iic iraniioraiiLtkim 
by mtuki of an add uJ the «diim of the di^tivr f«nr«nU which 
mubfl In the pnHlurlli»i of (i). Atid atbamin. (y). /Vvio- 0r fcArM- 
dft f — rt iCT, (.^), PnifMfi-*i^mi>fti jftd finatly. pfpUfUS. 

Certain Standard Tot Mealt htt hcrr ^vcn bui it ihoiild br 
TCmcmt'etrd that any m<al will pvc mmJlB if lU conatiliilian be ktkmn 
and ihfli tiEikiL] oKicfrfuilr i« nol «s^l£a]. 

BwaJdU Tmi Brcakhut.— One or ttvo iUce» of slak bread or o(tc 
Of tfto bakor'ft rolU end from 300 Eo 400 c^c ftt-ia ooc,) of weak ua or 
vaErr Thb rcprcKnl^ JS'T^ K"^ (1 <■> > oc^^ of talid. Ijui ihr f^^ 
amount b out malorialH It tbould ht taken in th« rooming aod retained 
for not 1t!as than ont" iir fnorr thaa onr aod a half hnun. 

Boas' I«at Brvakfaat.— One tablnpoonful of oatmeal la added to 
ofic <^uan of water ^d boiled down to onr pdnt. It ttaould be tatcfl 
plain uvc for a IjlUc saJt and removed in nol Iraa (han one nor rumt 
than on* and 1 huM bouia. J'hii irniikfitjt it n^ioity t-oijiofir la 

A« de^trminaticm fij wiiir/t it to un^^rUnf in tkis ditmit. Jm ri$tk 
Msu ihf itofvtorft ikc^dd he v^hid nrJ tJu w jibJ hejerr tr bp Iftr Monrlfl/ 
mthMarhijortthtnutjlit taleH.'io face £iMiJj break fast seldom cauwa 

nupuuaui \M nDi mivACM. 


■n; coofDiioa. bdk add not l>«ing inlriKiucctl in suJlicitct quAxithr to 
produrr iht ordlimj tllnJcil mcticwi sugjfFsiing cajrinoma. 

Tfae Test DtDDcr of Vod Leube And Rjeccl-- -4<w c^ (ii^u 
uc) cJ uup; jo pnfi- (s off,) (or Iwo ordJaiiy dicaj of wheal bread; 
loo to aoQ giiiA. (^ «c) IJMly <Uviilcd bcdalcak uid joo ca' 
(6 OS.) of WBltr cojaitjtuiv iht mnl. It is r^moiwl about 4 houn 

Tbfr Macroscopic Appt^nmce of tb« Stocnacb Coatenta.- One 

ur a/t^ in Fvali-1 1»I hrM>J<isf rhr apfmntxr ihoiilr] hr ihikr of ihin 
iiJkv. the bread ili parUclc* nlfacr tWn diatlncl friRimcniaaadljttk 

BO mixua pcvMnL The ^llnie ahould be dear ut thm ydlmv and of 
a ligblo4oj. i4nc»Jiij or [uaikvil ^jr^cattJrlT u mdiiutriJ bj utitliun^EciJ 
or aligM^ modificcl brca^ fragmmU. «lov filtntioi; and a muftly tnlor. 
H^firmh^ty bf grtairr A'lifliiy, fnamj aurfacr, alalia ackl odor and 
rB|Mddepafftof«odiinciu. ht cahrrM gaskiris ike thick »JImy content 
«rflh eviiWnrt of mbaddftir is dummeritlk' and in hyprrchbrhydria 
with ex(€stiv< mclUkj. the atomoch may b< rnilrclj/ ccopiy, 

Otbcf oocMJtUMU ar« diacuaacd und«r "tvrmtwt/'p 949«andoth«r 

QUALITATIVE TESTS.-The foUcwhig procedure b linipk and 
mntcnicnt;— U>. 7>jJ;iilrfElranlh£Dnjf0<nitf|aj>tf nrii^vtffM(ron2»vrrr! 
I, duiinicd valcr loo), or add 1 or 3 drop* of an alcvhnlic solution 
of di-amldo-flAJ't^niol (-S^)* fm? u^d la Indiiratod hy b1u«dlacob>r- 
•Uon «ith On: fonacx. or ird villi ihc latter :caKcnL* 

(b)' if* ^ 0^*01^ Of ilCV, ^.fir oiid fthould br cvught by placing 
1a ih« lol-icbe a drapt oj tar^lit ctid. C dr^pi oj ^uitd HnUurt oj 

Thr jUBrtfiff ft ika e^fd ir&p by dr^p itud ij U^etk jcid be presmi a dmr 
litM ytUrtB raui^ appfara; no aitciitiL>n oei?d tc |>aid to iloublfuJ 
tTKiiiina, Lactic acid ia alwajv abnormal if apivariri^ onv hour 01 
more after a Inl bmltfuLf (c)' Attik and butytic add* «rt 
levnlcd by the odor of vinefcu and landd btiitcr praJucr^d upon 
bcatfaif, Boijiic 4cid ajipcam m» tnnU cnly dtopt of rharafEdinTir 

*Or. a trw drmt rd mnrcto mhith-m in-uirnn 5 , ettir '*»\i^' 3.,Almlif»] 
I0a\ or. phlaroflludn iDiuiiob (phloroffiudn 3., ^-anlltln i., UcoZial lOCk) 
Dtaj br ndxpA Mui an equal attk»unc of uimc b 11 |H.Tr;rlitin cifnuU' cir on 
■DT abiir s«rfacr and vr^poraicid lodnanLfl i*a¥iijtti murfwi roar loiffr 
imdiMiing fH* Ua. 

tTba mcljon it iMcaiaSid brthakbtf Uf l^ 6];ril( nit£i Un tinea Ua 
■oliiet of dber, cvaponiiB^ aodiaf ■ (tv dropi c4 wxitr and apply^ 








OiTiti let- 




klEDICAL »tAO)«OfllS, 

U HLl, 



otW if a hii ol talddm chloride be addi^l ti> nc clhcrol rcildur.* 
Tbuc v^^iUe /iiiJy OfWi rttlilcn UUniu pAprr hcl'l crrcr ibctulM fhsiB;^ 
br^iTig an'l indUaU /rrmcn^BM. Incite icid ib ifcc ooly rermatliliQi 
jidd of marked ctirucbl iinporUnot; slTons^y fntgf^in^ carQiioni& ud 
prT>vmn fprmpfitiiioa and thr absrnc^ of thr HCL which nonulf 
dirckft fcrmcnloijiin- 

Ptpsin and Ptpiinogut.— <(t'iJ* ii^tnut/ <vr tntrruW JI>>dp0ifJUM 
acirf Wrt 1*1/ ii ifrtrtiitfy and Jn *ny e\cr( jiep«iimiecn may br diMTgatrM 

T««t. -ri^l>&n ihiYC tubc& (i), h'okr toc,c,+/«^>f 5^1,-f HC 
£f£f. 3 Jrrr^. (a). FUiraXf fo ex. (3). /^iftfolir to tcA-fTCHiL j 
(Mv^f, odd to uch A diV of CR^ &lbuznin &bouL 1.5 nnu tUck« and 
10 mm. in dinrnt^tft-t Tube (i) t«Ti«i u a stundArd of cooapulpXL 
Di^calkjo \a No- 2 JndlcfticA bolb pcpun juid IlCIJa Muxnber ^ Nunbcf 
a Jotitng, i\ (howi the prucDCe n( jjcpdn or pcpnnogui aJon«- Ui^tt- 
(kin shouH \x o^nijili^r fn hUjiiI ihirc hc^urH nl blrKnl brst bul mil' 
tidcrablc variation ia aUowAblv. J Aa & nilo P'F^n ftctivitT «ni] 
acJclJiy run pnra]!*?}. but this nilr may be (IffarTwl from in Fttrrtne 
hyperacidity And ccruiin ca^cs of suboddjlYp *o abo. if Quotor jufiidcnc) 
be pment., nvwn a tolaJ «l>«Dnce ol acid and Ecimcnis may caoMi Ivs 

R«iuiui (lab frnn«ni). — 7'#if. Add to 10 c.c cf milk j-5 diops of 
RMiric nonitris, kipping mixiurc at blood hcuL The apEKfrnrwice of 
cxMKulAtioQ within :j mi[imc» mdicatca rcnniD, ]( may be cnliRj? 
absTDl in carcinoma, arhjILa ^irtca and atrophic f^rilU, but U 
liie movt naUtant ^ Ibc fcmacnu- 

LlpAM.^l'btf tiaborate uct reafiSMt f^r lip^M i* oE inCfrnA only 
to labnmlvry workcn lu il± only cliiiJial intpurtAnn- lis in ihr 
ctimJuudoii or entire abaence ol this Irrmmt In adtylia gutHca of 
aiTOpbk guzrilh nncl this may be n^sAtmed if both HC\ and ibc fFtm^AU 
■fc aUcni. In any cvcnl it is but sGrthdy active. 

Albumin.— ThU ihntdd b« absmf ont hour tSttt a ic«i hr^aklut. 

Starcbi Tiic ditEcativc truufmrmab'on of lUidi bcginain lln: mouth 
trh«r« ptyiJiD npidly conv«rt» it into cmtMitt. Tbii tieromtc tryaif&- 

*A more euct (at £cir flcrc>c Acid demands litatiacn^ with etber, ET^p- 
orfttno, DeUtTAfiaalion of the clfccrctl rraUluc with dilvic hxtiom bydrair 
and tht addtinn of a drop tn evl> <tf ^itul* irric p«ichL»ri4», but the nevulu 
are not wot\b ihe libor. 

1Thr*BihmiUl Tv comtanTlyon liand lUid an nadSly prrpind, froio the 
ji/lWy lioCkKJ rof, pmnrtd in iilyfrrlnr aod nnshpd Mntr Aln^. 

tTlir DK-rlHt^Tni T^iomas and ^clicr drprnrllaf upun ihr difntlinf ctfa 
Holvttlaa uJ Dtftrin ia ^1% vi hTdnxhk-iii: ocM and ilie slill mutcuapli* 
i (Med oDg of M?(l E> too (unbcrwmc tor tht general pFaditioner. 

oiB&utt ow rat sToiLicti. 


dfslHnc nUcfe itrikca a tfolK or nuhoguif brrrwn color with Lugol's 
•ohitioo. I1u» in lara b«coaae» afJbrff^dtfxMi* (unafFcclcd by iodine) 
And makoM (rradfly ddectcd hj FehKng's soltiLion). Ii i$ t!V]d«ri ihi^t 
if tbe fpatric smctkc be nonnal ihc liydroihhrk Add will ]:ircvrni 
nu>rc thtfi B partiat cf-nvrTEic^ o1 (he ^thrcb. <k«pitc the rapid nciior\ 
ift llic j^tjratin. ilx mrul uf ithid) dc^viuL* U|mii ihc thuruu^intv of 
maMirttlion »nd ifcv chandcrr of ihc food u mtnUowcd it; lolalion lo 
ihr f«r«1nlion of iJir acid oin^iTlfml. It fa dirckttl whm the prutrid 
«f£iiFiipfa m utjsficd nid frtt add Appean- 

CHnirAl Infnvncc, — A fUMkfd tionh rta/iion lug^fiti hyprtaeidUy. 
II nmtktii tu:hfiH*dtJt^mt rtacium. JiminittiKd hydrinhiuru: udd and a 
marktd FMimgs rt^ditm d^d<d sutacidUy et abtmi HCI. 

Ttftioie the Holor Power of theStOtuach.*— isKr^ursdloltJiuulJ 

oho* <ii.rc-li<in ty Ihf ki<1nr> in Ir^m i lo i| hours irnt be cntinly ihikJini^ 

mrrunl in 17 hours. Ei ipprsn aut taJiryluric acid uhich strike* 

ft violet <olor vrilb frtric chloride; moot conveniently tppiJcd by pU<- 

ing a «^glr <fmp of the Uiicr upon the vrtrcd i«t pppcr. The 

Bi&lol lA nut aflTcilcid by liic i:iuTiji: juioc. Suvnil (til. An cAtrrindy KnuBbiMT 

urapCt tM corunelA in aJlowing a jatR-nt lu tat ■rranbrrri«> bbckbpmn 

or cfAn «iifiy fniiia m night rrmming the contmu in the aiDming' 

wbcw the residue aJiow the seeds even il tia acEual slenotii ifl prcieni- , 

Jtfflfr /riAilUt th4w rWur miifutd h lA/ rffnatnit of ihf lUmatk timtttUs 

ui At iMmirMf I o /hU itU JVflj»r or i^i/iiury n'tx^ Autin^ hun I^Acn 

Mr HifAf 6r/MV, UnS^ Ihrtt rMitfi/irMj and ^p fuw A<iiir:r j/£rf fAr 

BwM fat mfcf a A^t'rna^A ihifvid he filA/r ftUirrly iir appr,'.tjrn<i^ly 

*^Pfy- it a<ttnai jfnikifu. benign or mtUignanl. solid food rcmnani fiiA.ik 

f cp c ma iing Ibr nnddue of vr^ivnl preiiiikiii mrals m&y be presmr. 

Tbe tt^«rpli\v ftm^ ot ibc MoTnoch nny be le^ed by the KdmintArni 

lion of 10 Kniids jnf patandani Indide. in mptulrt, which nhoulri pnidiirv 

in Ibc Apututti the thMncsaitik iodine rc^rLlon with ttardi paper 

«<iihin 10 AT 15 minutM, 

QUAItTITATEVE TESTS for Frtt, Total, and Combined 
UjdfiKbiorK Acid.— V'j]^ ikrtf fiprlitms (10 f.r. each) of the 
mn fi i^n t ££ilTir mnienu;aild to one j nr 4 dmpsol phenolphihn- 
Ida >o[iilion (1% iJmhoItc sobiibn). This rubthtice Mnf: t^e Mt- 
tattv far crpnric lidds. acitt soiti end bark }riv *tnd ctmbinM iSCi, ^f(*H 
A'irafin* mlb aa nMd/ane i^ttlian tjj htaum tcmpvtiiifn, letU menmv 
ja« MM/ ar^sAiy. To the lec^nd portion add 3 or 4 drops of aJiaanne 

• Tlie move cUhoiaat luul end ttiia of Maihleu, Salitl. GoldKhmtdi d at. 
haw niM bocB iododcd- 


Unli'it iai4 








Li<»k Acri f«clt>>n- 

Tnl Acid hrf<m Adclfn|[ htcirnvb imtmn In Jbrtk erfi tm. 

1>i'«M>dc^^A0-bcfUQi rH<l>i-in for ft^ JiCT. (<]iiAJLtAhv« kit). 

True trroiiad mdifiti tot U*al attJtiy iFhrnulpblhiJciai^ 

Airtfrrdmt mlor dunflr in umr 1<?i(, >flt Iho IprmifiHl rrvrnon 

CoIot of MonMch ooittthfii aftrt wUing |«t wlaiVxi U^ jrtt ttCL 

TDninii tdur icutiun ^^mr lol (Culur jil>u ur-^rlv rri'rrvrnti llui 

MiuirK<i3 hy vininaih fofiimii aTk-t juMing inii t\mil t_iMixnm iol> tor 

cMbth^ El€l)> 
TamluJ cid^T retclloa dnHMwtf Un 

MiQti dll Acidt in «|»fnai'h conlvnU nc«pl caonbinrd HCI (m* Ica)* 
tht rmdl oblBinti) IviniE BdMnrtrd frim thr iirrviiABljr <le«rabv4 
tibial Acidity, 



^^ f^ 


GdMrtr Cnnlrnii- (Drawn fvum Arlu^l Sprdmmik t 

Coi>F of 

■olutloa (]% «queou»»ol. jduc«nn mDnowlphottAie of sodium)* This 
btimf Ihf. indUatff ^iv jrft atid$ and acid t^Ilt. metunrH ihc dif^tt e) 
acidily f^rpt jirt tlu cjmhinrj HCl (plij^ologicftUy atlivf sdt\ l^KJiwIy 
cofnfamtd with the pMritb); k<neehy anhirottinj; the rt^idinf^ thus 
rt ft wiMJ from tki toUjl addiiy (which rfoa include the comhinctJ arid*) 
Mtf itis tkt 4JH«in*l «/ the comtined a<id$. To iht third portion add iFrte iia. 
thncot fourdtopiof dlmdhyl'Oinidn-tKybcfito] (0^5% tltoholicsol.); 
tki^ Mnx the Mkalar Jor jrte hydratMrric add. 

Sfi. t U tUudyt white w ^-royijA, Sift. 3 a fmi^ht yrtiinv. Set. 
3 o thftrj nd if fm add tt pmtvit. Hip ihrer ftolutioru in novt 
Mdi I0 Ix litnEcd wiih tkciDormoI »odiu» hydmtc wluiicrn,* cmc 

ex. of which vil] nrutnliirr ^0036^ gmi. of llCIf li^'J'^ fteu^H- 
■otfrrr tf 'nuAAi dnJ /v»; pulsed tAt Inte end ti'ltr ftaffvrrii apffor. 
£Dd RcACtionfi.- rUc^t art^— /4 nilukMt t (for total ad^lily) a 
tfutfnU onti ptrnttfiU red wiuiAi <]ot& uul drcpciE upun 1[ic adJilruu oi 
man KaOU. Ifi volution 9 (for hn adde and add salta) a ^ht 
virfirf calitr; In «i.>tiifiori ^ (for fnw HCh a ^rnf ytUerw. One must 
carrfullv dot* at the commence mcnt of each tiiratjon ihc ciact rcadmic 
inHtnthg the hoiRhl cf ihff wlutinn in tht htirctic aiirl nji^ln Mkr it 
vo the firat ajrpciLiaiice of llic end tntitioit. TJif midti m^y he t^prtsitd 
m txacl Urms by midkptyrng the amowii e) wid hn^um h be nmiraihfd 
by t cx^ oj the NaOH sol. (-COjCj ^.) by the amount oj that mtutifm 
msed amd ^u aj^oin by the number 0} c.t, aj fiUr/jU ksted. Ejcampie. 
Aasumlng thit fi <-c. mp rwiuired tc neir(mll» the to c.e. at «tomfteh 
cenlenUi and knowinje thai each NaOL^ unit oeuLr&lisc* 1x00365 of 
addL tb« lonaula bfcomcst— 4 z 0^0036^=1^09190 ^sim. (for 10 c.c) 
X to^=^3i^. This u oDDunoEiIy and more convouectly fjLpicucd 
h]r figures bo^ upon the aj^ucapcionthotutocx. of itomncb contents 
rei^iml 6 at NaOTT fnr nemmJisuition 100 wmiM irqnfrr fio. or if 8 wrrr 
uicd So. and ao on- UsinjE the Utter form oi notation ia< find that 
normal fnw HCl varin from 30 1040. f^, .073 to ^1^0%, TnuE aridity 
boin 40 to 6op ix.» ,146 I0 -Jjfn acd combined acidity a1>oul J^t tX., 
.09%. one hour a1l«r the tear breaklast of EAcild or Bou. After the 
Ricgd mea) (j homv) the total addity ui about 110, free add 44- 

* A 4f<iaonnKl aolutloo^A, of the moimilu stighi of ih? Dub«Aitcv, In 
9«L. 10 1000 ce^ «! ditlillM iratffr. hffOK ia thff au« -^ \ nUH the nwlec- 
ahiT wight tnng 40 Th^ «nJittinn mnaini 40 rurti to |rv» of HiiTillprI 
wnieT^ (A normal mlntlfirr^ihr mcilcrultr mlghl fit the iiihunuici? tn lOO 
pan* of dUtHM wnlrr) 

TThe laa thai tbc ihrc« ri^hi tuad fijfiim corriopoDil to the DumbctQl 
days ia Ihc ordinur >car i* ui aUawAble cmteh iw a UmpiniL v^et&un- 





The pro CUM h cxuvmely simple AAd no more cotnplUftied met^^di 
■re M «]1 c»cn1i«l far dimiaJ vuik, II jAitoM £« rmvmAtfrAif f'btf 
tlfrmHCiiipf4tMtUitlktanfyatidiit auMnatUm. 

RiicapiniUrtoil,--Sril. No. i (nlw-noIpihthjilfiTi;* nrjirl» fo frfu sfH 
Mid m/Jj, (j«d At kMeij otifihintd aad^. u f^ynk vMk aad doudf 
and piv« a rod temunal rMCtion. Sri. So. 9 (aliairui) 

iiUlrg fur an f^iimuc oi the combined ftdd the tublnbdiori n/ IlicrKull 
ohiAincilH fhiiTi i\\v fii^tm'H R:i-in:»rniinft the loul »ddlr>'. The mipmai 
t^itrr oi No. 3 u jrclfuw, ibo fnd r^i^M-tn **<^ .Stff. A'0 3 (diinciiiTl- 
Hn]i(U)-4A>'bCTtn)]) r^^ofte or/^j ie frt* afid. it on^miUy eMtrry ni. 
. and ik md nadio'i ii it hrilShrtt yfihw. rballv. Ihc morm^ tdai 
aridity ii 40-te(-i4t» tf -t^/c); At comtvHtd ainiity 35 (^otf'^); tbt 
iRirmii/ /nc //C JC»- jo io.^j (■> -146%) ftftcj 4 IcM biakTuc. 

Sourc*« oJ Brr^. -Tiiprcr^ isethod » bcr* f^ven b bj far tlw 
muM ai-cumir an-J mtivcnEntt for cliju'tal work anit vhile »K);ht!y ioaf^ 
caruit wlwii Frte hydrochloric tad isabsciil nptdally in ibc preaence 
of an envKivv am'iijnt of the onpnik tddi. ttoe erron ar^ not tolft- 
deiil Uf liiHiiLilify Ihc te*t for ihc Erncial ijrwiiiJi»ncr * 

Efi«cu ot Difit.'Variationa in acidly, part^ularly in frw kM, vil 
uf ttjimc dtrjA^id aomcwhal upon (l£cl aadaneiitmiircAinuuiii of aalha 
nay ntuMkt tin sasiric cimUiUa; m auch caaea Ibc addiliop of a ^ 
dnipa of dilute HC3 tnA 3 or j dmpft of frrrir rUnriile vdalirui bn the 
•IctaaiCh oontcnu mtiKi a red coTor rcnctiijn. A» tlic «ud xfEniiic:* of 
Marrhy foods are mdHy utiiAed iinil th^t^croAndaof protrl^l (itihfianca 
much jcmtrr, At Atjt^faf acid tW»n orr Jtmrul iit mtoteaknamt (At tmpnt 
in vfgfta^am. The mora UbvnU Che diH uid the belter the nouhsh- 
jnetit (Jir niure the aod, II jn evident aho itat the rt^iJ talue of our 
fijfjf« U reprwcntci b^-tJic*' combmcd" and " ircc'^ odd pcrccaixjcta, 

Tbe DiagDOfftJc Bearing of ttic Foregoing Hcthoda.^Fof tasty 
wort Ihc men <ktertniaatloD of frte IICI ia mual rcadQr achEcvcd b; 
ihc uar of oii^i'CTft pH]i«r coKtly iJrocuivid of any di«mil1 though ft t^ 
u» Dotlimg raw the haxv ha lliul HO la pmenL Tliis being the caie 
however ihe pmcnce of normal fefmeota b muoily x lair preaumptloB. 
Wood imrru the phj^dclnn nfoilaxi pladnfc ion much dependent tipott 
Ibc fim leal m«al. riKHly etatinje ihar onrinx to the emoltaaJ dk- 
luftttnoe, the rnulis may b« inUleA<Iirg, Th« unae rule naj 

* The iPivthoda of Sahli, Rownflr. M lutiui 4ail Liitikc JTiny br found in 
wafka flvtDlad to clminJ dugnoaJ; but are 100 cMiiflii:iir<Nl far ihc use 
dv prtcifiiai ptafildDit- 

Docun or tbm •tomackl 

Applied to KfrnJ succvMve tests. Zr ma tcldom hippou. the iicr>\iub 
dktnrbafiM OMitinDM to \tr rxcmuvr. OrdtnjiriJj vrt- hait to oofuider 

(I). flOKJlAL ACIDITY (mcfalorhydhi). ThU cxd«J« odiylia 
pstnoL cbrank gu<riiu mttl umuHy cxrdiLciina of llie nonuuli. 1( 
then not endude gftstiic Mtonjr «nd diUiation, oerroiu dyipcpsk <« Lhc 
fttK CMM to whkh raidnomft dcvrlops upon tin old ulcrr ba4r,* 

<a). HYPERCnLORHYDRIA \q.>% +)-"Wc ^Minin^iah bf- 
tw«cn t^ iPcmK^n oi riiYHJvdy acvt gsAlHc jiim <Iuring tt^gctttujc 
(hypadiloriirdim pitjprrk uid tbc «uac condilloD xppaiii^g in the 
fMtwg itanach uid npreftmiing rironorlaMOoniinuoua Ayj^flfjE<f«fw«i 

intcnniltefti— A^udAohV^tfOdtf)- A5 r«|Ei^nlf hyptrchioHtydric proper, 
iti chkf cUnlcn] tmporUQcr dt^irtii^ upon iu Irrqui^l attocbilrnn with 
ulcer of the BtORMch And Lhc ptiuihitity ihfit It it tk UcXar in the pro- ' 
dnclvo •t that iMion. Simple hvprnvoviinn moreover it oommon in ' 
neomlks «iltloVl ulco Sfnaptunu. in lhc ^siliit ciura of laha dorulJi. 
hOSmrf tnpa§fm(Ui_ and. ■■ a UniporiLry ^cndiiion due lu cili«ti«iion, 
rfDoeloAal dtanirttAnciv cacudpAtbin, dietnk Fmin.nvrniv of alcohol 
and tobicco or cren to apcdd uljclc^ oi food. 

S^mpMOii'— lu (jnnpcom^ arc no doubt Khi^Hf due to an imo- I 
ciAtad hjrpcnceUiraJA of iIk muoosa. Tlie [n-nt cbiuiickdatic ftaruie | 
b Ike oorahfliAtkQ of alight or d«tirVI di^itiTi? rlisttirbiLiia (irpigAfi 
irk opfiiffwion, pyroUL icgut^tolicm. dquvui, pcrlnp» v^^miung nnrl : 
trrrA fit fff al^T ^*jf**^* P^i" ^^*^ hcti<lad)G) trilk a ei*an ttngm. The | 
vtlAcka apfkcar ln>m one in ihree houn aiirr r nval. an* rftipvffl If ' 
vofBiliDg occuiA. or o4ten (tcjnporarCljr) by laki^K riiint^^t^nnu!! FwhI &nd 
are n aO <b*b am^linntitd by ih^ adminiatniEon of tin ulkBLi. Sti^it 
diftat icsdcmnB may be prcaml nod croaCipalion ia th« nilr. Tlic 
aloaiadi oootciiu are lasnally dear aaid lo ititr laitc, of low tpcdiic 
^vity and vQl of couoc diow hi^ add valuctt iiid uniun^vned 
Btarc&ca. I'be urire al ibc hcijchl of an attack m uftiinLJy nculral and 
deporilt pboifhAirji- In urutc nUackt the fnin vany hr 4Cverv inrj 
■trcft^ "gBT^* uk«T MTG that it a more dilTuMi, ii relieved laihcr than 





■rill illUII 



A caae tt^ttiti^ a oradual irtwfDrawrkin from thu t^rmptairw bnd find 
d tokf DO ihMe oliaiamil pylonc caidnomn hxi rr^cnil^ hten unrUr . 
BUlhsr^ c4MrTslfo& The dinlniCltont vhUe in itrticThl currrrt 4Tr by | 
no wcau imvhAbW (m ftk^iHc nhn for funhct ^liKUuioa), I 

tAftv a tai kK4k^ the free a^rid *Kiclk u [Jic detcmlnin^ tactur will 
CBUcd liO. the lotil aChlity ;«- Thr tionudi 1> (rrqitrailir tntjrcty ^xcWf ^ 
oa« hoBT kficr ibe amaI Imum «f ooiJ^fidfot inctnaed idoidv boM^*! ^ 


lao4 wd tli* OBdUon ilsfti lonoc 

«bcr mdoDcn <4 mftifcccl maliratHltiM kit Ir- 
■tauioD of Ingerti. Tbc ijipMne 

Tte iftdode* two cfeM inM 

Bukc^ br ikodcd bjpmckfilj. In TddK 

4b BCRwr of MoBKb oontODts m th« taacac 

foivwing ihe eUologr ol dm- 

il Q «lta MHKMlBd vtib oker ud m«7 ocov b 

flrdnsk pnutii wfih iufiind 

■i^ he madjf a dnnk ionn of wlui m 

The qrnfUoBft uc tbooe ol tbe opA- 

MKMi waliiii^ fpi^utric iSitnM 

b li PcoumM. iMtinf from one b> 

■■4 Iwdh a<< g ^ M ft pton txaaa^ MtuAl dit- 

nd diinak hTpmrrrr^ 

which occws 

■■Mat.— Atettita|j ttet tor Ibi prami thr tjngncj; dtadficft' 

of hfpMdlirtgpAn «>i lij^jowmrion &iib( be pranved. the 

mUkm h wma^mf fa MoqiHS it in the Bdhridual cuc> 

if the biq^Hqr «f M iwi ^ fgd ^«ife itkcr imI i)v imb' 

«f Ac MbmmU Kmo tavB. It fa trjc bowrvcr Umu in 

ibtt |Mfa and wAmmii ijr eKor ditf teftly baltzffft ^ f/rra 

«■ i» maaMsw iMVivy or pcrfoniioa- 'Jh« qfaai of 
iBftX be ASDOilcil vMh diixi byper or bjrp>- 

(j) mrPOCHLORHYDRIA (Oit— }. Low HO v»I«m pofat «d 

M wlibo«i MmwA the cftdj Mft^ cl ubjAi foi*^ ukI aha tfi 

14^ AKACBLORHYDRIA. Ai « ifviptem Ihis b of pooItiTc itid 
ckcklnl value, ihougb OM wilb in ittUia ca«Gi of Hlvuiirefl difOOk 

GAmcc Nnunoaicft, 


iti» u veil u ncftiiy ill Kulrk okrcinomu* pcfTiKikiu* tnvmiB, 
ATn\. in Ach^Ib fpstjU^ xnd tme tlmpttic gMLritk, In which th^rriiatlKt 
an entire al«ciKr ol lljc DuiiUft] feruiciiU. t'tiFurlmidlclyn ULLord^ujg \o ' 
th« aul^r'* czpenrticr, irunj cooei of dj'apqiua apparoDtJ)' puit!ly| 
noraiu,. and vapediJly thoae «rctiin|iimted t^- mitrt^d ntftlouiriffan 
due to ll»c coauDOO cmusc (vie,: chronic Anj^ali'^n induced by fool ' 
bhir ntiricted tad moaotonom Aitt). ihow ihJK rondtif^^n, ihc aM 
rctfrpe&rinic aIIjct a abort period d trtatrucntH Tlii; tapt U tlH-rtfuit 
<^Wfl7 valuablfc fa connrciioa wfih th« uaxUird lyRiptdm* (vt ncut^ 
uid diinnjc ^^ritK cancer uf ilic Moninch »nil Achj^lu gulrita), 

HtttfOclifliA- — Thb ifl mrrrlr a c^nvrmitcl [trm coVFiingihc cma 
of dccUnl vattnuiEaii "ivriaSiotu in sccrrikin tl muy orrur fn hrnhh 
or Ea any Conn oE fpMric dittuibonir. funciLon^^] ir oi^iinit^ 

TRO-HTTESTnTAL SYUPTOMS. A^mic: iwm the hyFTcncmlioru 
pntVioualy duciaHKl wv niAy <^ncouriTrr Htvrfis^i ffJittnj; ttt ^jir. I«ii- 
dermis. ftnalMt ^dkn. fruttaihlts. vtrmilinfi. motor spunn er fci^ixa- 
9ion^ apptHu and Vitrunis fOfi^MkaUi. 

Appetite^' Atwrrjno:—Ijoat <it ippFliET thoujch rrlnttyl ia rn\ny 
coB<Ktfoiu otay be dcACnbcJ under thii head. It a pnacat in all 
levvA, in maay dirnnjc ejJiauAting dii«aM« an'i unrkr Ehe ktrm of 
ttoIcoI emotioii (gfkU vfotty, uaxiy). may bt putelj- hysterical or 
ncunsllieiuc aod may Ulw the form of ni£r« loa cf ihc hungrr hhk. 
a<lQal R^Hjlaion, a sense of rr|ilcikm> acluAl pcrstr^um, ut. nausea 
upon Ulfn|[ a ili)^ amotiai oJ fciod. CMorov* chroalc alcobolifln* 
hyvirtia. nrrvnitt and rmoilnnal cprrrarmJa. InfliicriTn ami «rpifr pmi'' 
uoca btduding ad^'anocrf iijLeri'uLtiAi» at? »jmc of t)ic \>C9\ kruum 
cmnptcfkbatapiathvaulbrrrwfiMhl i-rn]>lia4J/e l^r fr^vjiH-ruy of chroTik 
anocuu as llw reaull of diclrtie fadi aijd Eiuido and narit^wed luon* 

SullmU.— An buliabk and inonlinate craving fnr iwid h onv of 
the miLrkcd aymplonu tn ccrlafa cuKs «f true dkabclc* and occum 
norrninr in rAnvalnrf nrr from tf\m Kiif h E14 ryphnfd and ibr rxunrhr- 
mAlO- It b md milb ■» a n^rrviu or kyitrrkaS manifcatatiira u wcU 
ai in ccnbni disrasF, r[)ilq«y. t^i^ophfhaLmfe piitir. Mc- In thcbyvlcnc 
and iwiiruiliemc two ii maybe usodaijedivilbDJiabacaccof thcfenv 
of Mtlcty (acboria) or there may be a cravJQ|c for unmual. tecmmxiy 

* Again aad agAla ibc moit ■>b0linii:4 ca»«« of dT^pcpi^ia widi wnpkir 
anorexia and cacnaive cmactaiion are profnt'tly rdlEve*! uadcr itix r»l cur 
a»d tbo gradoal iotrodvetioa dI 4 variod and gener^iu <il?Ur]^ 

I«>1 *lh*r< 


or Bfiqjitl^ jnjurfoiu. or posdb]/. dUgUdObig flnldec a« 1i ntiMtml In 
fiyMcrU, piqpioncj, chkirMta tad to ft Icn dtfitc is cliildbooci vbnc 
ft no 'Toubt orcminMa rrprttirntt tn fkonn«] cMldmi a gviuiike iliw- 
ittnU u«n] ill Au far aa ii nlutfa lo 4 viul i^po of unfinary locd, tU 
crtviuj' br swnla an<\ fniitA or ihc prdcTVoc? shown tot afi cxdaaiw 
NUrdrjr m ptntdd dkt bdng im ofioi cnrnhsitefl br pAmti. 

KAUSEA AND VOHITMG. Maj be other tminil or !»>• 
tphfTdl in (^hjpri. ihc rifn;rr bcbfE closely nlsttd to lb« ivpn' 
lory cculrt iiE ilic jitc^luJU Mulur unpubca to \hc JiAphnsa Uott 
the ptumic nrrvr; to UicBbdonunAl miudMy tb« micrcoctftb; while As 
^rnorj mcaugc futknTt the mgUA^ In gutrk dJwp iW jut U 4li- 
tindlv rrflcx. in lo^cmic cooititiou diie% ccnml, Purrly 
fTilhimm anc nip*hk nf pnyhidiif ft u bwpa fn hyurrfi^t 
and thai attocklcd irlth profound tDftotJoit or mcnul shock, li 
tvUitwi to ftp«dftJ wnnXfoc b fttown by ibc mpoate lo fool oifai^ 
(jbgiuiiag tuto *nd ahuduDg apccudcs, 

ToxttEWi VonUting.— ^Th« toxins may he bdiclfrul u &n Hie 
IhtmHU. jJAfiLinioniu. muUrui. at Kvevt laia^nn^ In ^rxirnd. or 
bkclcnsli ■« in unemk. diftbdc*. Addltoo** dincuc, piofound uicmli 
or cnttin uflotnunlfiLilonft. I'ltithfrmoiir on« miux conMdcr Ibc 
Bdiofi of 9uch drug» w tpoicoiphiaL. ether and chloToform uid ibc ttS<%.\ 
nf dctetenoui ]{*£« incl thi; ov«nise of alcohol 

Reflcaand Central Votnititi£.— Ai npTnunororafnompBiiinwnr 
nf ap^iUJty 90 oUo u a rc&iill of bmln tumor, mcTiinnLiisp Ihromboai 
nnti rmbollBm, tomfting mzy be a mukcd auid ^omrvtmt soggecth* 
fntim. la anamU both ■utoiiitoxintii>Q aod ccrcbrml dbturbud 
rami he coooirl^rTd ft nwnrt in shock, roliipn and occatvuuHy 
tci seven concealed Ixcmoctha^c. Mfoitic's diacuw, tniertLie ajj j h j 
the tntiscvlnr mfii^dcuci^s and tvfrictivt cnorK btn^ by thr oc4^^| 
Votnltlng «rtejiiUn£ dihturtianrc* of oiiulUt>riuni a^ tjpifinl h/lV 
aickfiCMlavdl knovDand in diiwwof chrnbdonundorj^KfialhesCoatacb 
b ot CDunc ihe BU»t fm^umi csiur of ftflei voiriTTing wheihrr ihtf« 
be Actual inflammation, irritation, fUtiUena: or tften dutiubaiKc* of 
wcrriion. Untkr wnSar ooDdjliooa It may atbeod ftilmcnin o( rcLiicd 
or nd^bcpnng orgnufucb aa the Ur^ and mall IiLtrtiinc ihc Appendix, 
the rrctnm, liver. fpdJ-bladdcr. piincmtc Ic^dn^^y ^nd peritooeuni' 
Aa n^rda the rcapIriEDry tntn nffoiitnji b rradjly induct by dlrrci 
tilUlatlon of. or fouJ secretion odhrrcnt to, ibt nAjo-ptoTynigcal mucuvu 
munbtftfif and nuy be aiaodated utfb paroxysmal fough as In ponwb 
or picmufc from modiutiaal tumors. Cirtukloty canica a«idt tnm 

' uiciniA and ardjtal cmiECsUoii 01 bcmouhaKT may he due to dirrct 

I prcnnre, m in pericxMuJ rffijikiii, or 1 scconduy oongeitiDii of the 

ftbdoraiKft) vficcrs in vhIvuUt or myocsnlEal dbcuc- Aattic frvm 

' Lb* kidrtCT ^^ urimry inct b ui bfrt^utnt ti>urccof virrmitinEbut the 

gmiUl IfUl lunoihM mAiir r-xnmpl^ m In Thr wimitb^ nf prrfpianqr, 

uterine c&pIkbrkbI uhI ovu^n or iMlicular dLxiiv:^ 

Pointt to b» Etpvcinlly Noted.— Xhc«e »r« (4) frt^utmy, (b) fJi« 
Mar tfj day #r «ii:'>'- (^^ /^"< *^^ ^ pcisslencc or ininutAbll^ty, id) 
^tt^iai^ lUMSei, (c) iJs fd^Oitm h m^ols hoik as io tht tJtaraOtr oj 
Hu /Md 4ttd Ae iAw ^^H W"' fnxuiJML CO '^tu (A«riur<v '>; r^^ 
pawIma. tWv; — Amou«l« color, lute, tbc presence cif TVnuiantsof remote 
moUap and tiTnr*! bright rrd. 'fart f>r of Ih^ " OifTrr i^munrfe" ifirirty. 

The Vomilua,— The general appenrance oi voniiicd tnaicHd la too 
well known to need de«cripiion and il u ibr lignificAnt vnruiioru thai 
^tanap*^ our nltcnlion. The lunounl. iiainl or cxtittviyt. t^\\[g!rsi^ AmAuni 
hjpuvciditf >nd (irrontii oawilily tin ihe one hand, liyprfiicrrtionH 
dfiUtat>un or )i(Drty u|iciti tlic i^thrr. I'^miW U"n j ^a^rffif Tfrwrw^ 
1/ (iror tf*d 0/ 4 ihatpiy acU ^ie ttnd fldw JMr^^jf' h\perKcrtfiffn. , 
fjf iJu Bvffla tonknl 6f fdrj« Aid lA# tcmsue mulfd ganH^ taiarfh 
M iU/aciiai^ D'MitKiky httwus Vt/railitti a ft ^tiiiLTTinri tn'TiiUliV>li v>f tt;i« 
ocutc i&r|]^C9Uon but if pcnifticDl m%y ilt¥.t f>oint Ut \iyiim jneoia- 
pclencr or duoclen*! fitnoils. slmiile. or ucr^ciutrd v-irh ulirrniii-e 
or mnPigPBF* infiltnitirin. Ic perttoaitii, or, to tnttatmnJ obslnjction. 
In the two htler etrndilion^ the vomiius somi |iTr>ienu an untniitflkoblc 
fccaJ odor, ifwew may be intimDlely mixed wiifa iond m\<ii\c Anil 
vonblBd At tbc oabvt u in i^iric cnurrh; it Ho^rcuEcni in h} prruciillty 
■ml ftfMclaw ukd ilringy in Miaddiiy^ In hvi^^rMiJiiji h ia «urii 
JJMohlil >nd BO ttfunUj poinU to sub cr jnaic-utiiv if pr\-«fTLl ul th* 
lidghl of digniicTH. /^M nuy br viTublr iti tarr ttistanm cif guific 
abaom or Ihroujch fiattilou^ communicAlion with abKesocs cf otlier 
iirgtfin In tain of poisaming tbc characteri'itif cdot of ihe laxte 
tiubstaaconttybctvidenlandin aaa of lidJtj arx^ irnirtid trrmmltiiiitrt. 
bitlyik. acetic or valcnunLi: aeidi may t>c delected, /k 4i4^-4tnef<t 
ntcrrctiiM mrttnuma vt iik the prcariKe *>f fojl puiuk'nl iimtriid.! from 
whntcncr svurre Ih* odor n»y b« pct-uliirly puinlactit-p and b unemia 
nnvnooiaeal Variouh |ancules nuy be inideai to ibe nnbed ryr. p^ramte*. 
sudi a* ronnd fronDO, iJiifod wonna and ae^mcn^s cf lape worm, 
Tltt ofkr ia.Mlde from food arlmltture and cliucitorBilnn, ydlov irt NnUtr 
anadi^ly. peoi fntn bile conlajnlnatJon ot the dcvdopmcut of {trtun 
jiiWi_ bill IA OTilirLarilj difty gray or gncenialt bronn and, n.rtW, ro«c 








ralor fran Me deawnpooiiian with hf^ iddiTy ^r In ihc a&:i> of tobs 
clofMlt» (l-orcnx) with hype occrcf ion- Bik may be present id Mf 
vomftui if The rforiE aiv pmlonj^d. OtxuninA ftl ibc GUtsrt or p 
rqmted ali^l :iliJit.ka i( slr^Di^ir aueccMft pfkiric or ducxkoAl infcltra- 
tioni m the Ulier cue ^n<rfaiu N^niiim whty 6t 4*mtntlr^$fd hj ttf 

Hjcmatemcna, If the blood be rcccnilir effuvd it « brt^cbl nd and 
fixivt if pnUIIj fllg»iccl It iTseTnbl'n roffee gmuridi. M In an EMef- 
moijulc aUgc kikI in wfTidmt i^tiAniiiy ii may be clotud. Tbc appear 
Bocv 0I bhMd i> liffiulntM by Jrllir^ uifl Jann. cocoa, coffr^, b<«f jtttoii 
KLidi drup as iron axnd biamuLh. (be <luk red wiaa, gnpc juke 
fniiu such m ctimnt», cinnbenieft uid chcrrmL The acaouDt ol 
mjiy be Urgr nr imaH aod ibc mall aniounU nujr be dcrit«d from! 
»i>urcc> \ni\tcA a merr strcakinji of mucaa nuj acoompuiy 
and firraiitirnr vomiting und Lnrlfr^r (in ntdoiK lecinn, Oa ihr 
other hui<l. hemurrhA^c^ uf aU dciptc* uwuc in ult^r uid cafdncxaa. 
splenomL-galy, certain tachMic oondiiiom of th* btroonha^ type such 
aji advani-cd Icukemix liErniGfiliilia, »aityy aad puipuia. vinilcnt irJcc- 
tion« (hicfly associaie^l vriih irnpica] levtn. such aa ycOoir fever itod 
firmirir->Eii4 maUrtA an^i, tlir Mtkin oi irriianl afxd conruLvr (kntent 
Blow) and iroun'Iar ibc nances i^f fioflfll obwrudion, chronk facvt 
dUeM« and -ik^iriam :n«n4ttmJ4tir>n miint b« onniidtrrd. 

Sources of Errof.— In qom bitcd- hasnoptjab. tuj^lui^ lonruttat 
abiOii and bimLUr conilitioni the bli^od may be iwaUov^l uid its 
aiMrce nuy be n'tij^nitfii only dmiu^tj the pmcace of ihe caiiMlive 
facion aamcd. In hjcicoplyvia. ciic blood ia txig^i red, fiolfay aniJ 
of alkaline mrtinn; ihrrr are u«iully [ihriiral fd(p». rough ind often 
dialinctiv localixinif »vib|cclivc MnulifmA.* 

Chemical and Hicroacopic TcBta for Blood.— Tht fcJ^owifi^f tea 

vrOJ apply equally lo blood In tW .iLooU ViJ 10 Iheatom&di runtenia 
and It muA be rvmembcRd thai an cxami&alion ol the stooU la oJ Ihe 
uimiM tR>porunoc In all cue* of auppnacd cardnoma or ^uitric nlorr 
vamLtiag being fnqLfntly «b*entajndi]ij{hth«motrhi^unreroi7tiacd. 
K^rfMr>( jvji (5mftnd» ihar a portitm of the fuspen^l material 
placed JD tbc tcat-tubc be trralcd iftilb acTTTaJ drops of stiong acetic 
add and shaken vp ibonnighly vith onc-lbird tti volume of ether, 
tbc supcenstant ether Is pipclled cdT atid if aecc«ary cleared by addini; 

*Tlinii|Eh in hrtnci]iiy«« ihr bUnid b rftlKn) hy oxjigklrvB, VomlTlng is a 
frv^Ufiit aiccaiuponiJDem and may pivikHninaie* tbc tvufi bdoff m^. 
lleihcT too much >irtu ktivUd oot be U^d itpjo UUii u a ditTcrrniiaJ foctoe. 



B lev d/npi M 3Ji:choJ and the M^ulion iihould then thow an Abaoqilion 

band* 'i-ifraiin l)j» ihc fjirca vtor iijirtif*»HtTHK;, OmtiA' 

mm TViJ.— 1\> Uji clherail vxtrad nuty 1x' I'tttcd ro drupttof frcolil/ 
pnpmd tiaciun c6 gu«at and doublr Th^ arnnonr r>r old tiir|wntrn«. 
Uood bmg indkatcd by tbc Uuioh or purple color, vhlch cxn b? 
«x<ndcd aftd better defined if stu^en up vith chlankForra. The alco- 
hoUc mnKt uf Bjultudtjr'fi alom may reprtMSkl (he linrluic of guaiac 
ift tliii iMl •&<) U U*^ LUbk to diaturbunoe fmm irec HCL 

rvicAMiiiiM'j Taf rtqufro ihp carrrul rv«|>iiniiiu[i of iFit s\i»|>cvied 
material 00 Uie slides ifttr which a oyaml of sodium lodMc or sodium 
cMoride V addfd. followed by a drop uf gtadnl icMic add, Too rapid 
tfraporalkin u pir^^ltd by Ihc luc of a covcr-^ua and H ii ihcc gcAlly 
hcaied Id Ifcc exact boilmfi poiint. frcih add bcmg addtd as rv3|uratii>Q 
pM* ua, Wlicn a hfuwo oiliii mppcarin IniUcailnif thc^ furiiuttiim <jf 
het&iOt confJcie ov^poralEon it jUluwcd ani\ a ilmp t>f watfe run un<lrr 
ihF roivr-alipL The tnicfuaciijic will ibrn iTiow ifee rtuir^4.-irn»l!i. l-tatk 
or bro«-a ifacmboidal ciystab of hrmin. Iron causes no dislurbancvof 
tbe fkmk-jl tiifi for blood- 

HicroMopIc Findta£i.— The t>od dnniuAdc|icndt uvun the <barac* 
ttroJtiM meal prcv^ouAly lakcnutd the time clApjiin^iinceiUifigvalion. 
but. in genrxal. consLilA uf iuuhJc fibrn and aiarch paitiikamurcor 
Icaa changed by cooking and dipslkm. ihc former bcin^ r^cofrirfed 
hf their mjirkingi. ihrr U iter by tbrjr peculiar furm knd !<fructure 
or ibeir blue naokAi vritli Lu^^i 9i>luiiao. Skin* of imiu wedj of 
bcrrica or even more digestible subtUncct remnlnln^ liom rcmoie 
tucala potni to £a)p«iRd muiih'Ly i>r a^iital vtrniAUn iAnu i» i;idiiatal 
by ;aven»rnl «piihrLuni and th« w>-c»l]od b^jih^ rorpuidM and the 
Yarbiu vri^;c(aLlc trlbi ait usually lu pnulLir uiid bLcarrr ax lo ai vntx 
nggori Ihcir natun^ Kat nuiy nppcor in \ht funti of crpinla or of 
the bighfy refraciilr rlmplrla mjubl^ in irilifr. sEnir^inf omngr r«l with 
Sttfian m ocd bLid; nilb oanic add (i%). The pretence of a few 
red btood cc^tpuadea afoer vomiting or the paaea^ of a ttomiLch itibe 
b not ntccMuSx l^atbolojiEc. Mtioa may be lament b all Jcj^icrb 
an^ftp'Ti^lE t9 ib« catur* of the kttloo but i« rarely atiwni vnCif^Ey tn-rti 
if nn he prrsnl and may l^ke ihr funn of mail like manes, Sudt 
OMCM i> likely to be from the buccal CAvHy or eMpbagw. 






I nd ier«l^ 




*Xb* atwuiition ipKtnim conaista oF one HErcnglv iJcrjiinf band In ihe 
red Ukd three Cm defined 44 i^ften cn|ir?li' nli4en|. t^jne m ihc ytJtow. one 
befrtvn Thr ypUow and the gPKn ftnil tnoi^rr beiiHen ilic ffnit and rb« 





tticuli. the kpEothtU bucnlis atitt iho lidicfde booOua arc ike ant 

imporUAL In cirdnomk \ht BouOjupIrr builJat it ppacnt Ib tte 

fonn of Laiie 1ot>k n>i]ii ficijucuLUy armnKtvJ m duijcu Biid TTtift'fy 

LppuihtiK. ; |,p,y„„ ^^^ Gr»jn'> tobtion. wbcrvu :hc tcptoUirix wluch rvacsiblo 

k tfairt blnr^^ ]t noi only Indl^ntCA Inrgp inKmntH rif lnnSc >Cid btt 

M prtstHt in SoT^ OP nwrv 4/ f ^ «^aj h/ ^infcr 0/ EAf iiABbK^ oW wMrfj 

oftcayi afrjm/ in nmpif d^hJjitian At Ivni^ sUn^sit* The SVfvtt 

OH tAt c^nlrvy are prt^cnS in kir^e numbrrs » that heui^v riucs tMtikj^ 

\ roedy in acult or thrtmic g^Onlit. limplt 9Umy, uifrr «flJ c^mar aj Ik 

tktmack, hMh itirlAfKcuLtikinAll vartdy ajipr^r ii»iUly rj4 Ef tmnpd 

in b*lcA. Yca«l lunjp ftn pitjtcrit in Uitipe numbers in markH ^fjvn 

' of aton)^orrfl«ii> hi^ AJ-Miry,iinrhingKl4iftr<h ^nulsiiillW 

plcixtiful, 4Jid in 3ubaciiJit>- ihc ihukIc tibira vill be atrrupondlac^ 

Rumeraui in their ddinile md unchan^ form. Jhr Bou-Oj^jkr 

, iMcilli u«ii«n>' aboiin<[ bt lite brjer <lou scimtrlima met with in caiKrr. 

I Cuicor Celiii. -ttu«lT «ine findi dcUrhcd p&rliclcs 0I new ierowtl« 

[but (iinir olu'ii VII }i fiu^rrnriitM nfT itliw-ni nr iinrtcci^iatAl^l^ 

, '^Htart Bum," n^yroris" <.r'' Woter anBh")toTO» . rrpir 

f^tfltion of iiDm«ch <ont«ou cornmcjn in many foreu oJ guuic diatub- 

HAce, «nd ffwrycUffiBj (rumliiAlicm^. uMudly nbKrvtd in neiuuibiTii^ 

hysteria. I^imry of cpJcpay, mrviv iWunf jj-y rcii^rxiution and reraaiCi- 

CaliCfiof llirflHIrl. 

PtrifttaltiG Uiu««t (aupenaoLiLityp hyperUncuB).— Thk tnnible- 
sam« ri«MJvr motility, ii acciim|aniFi] by noisy gurig^infj nnd rapid 
croplyinK of the tiomitcht but rcuv occur m Uic cniply orYin, )| it 
B eoniTnon Imniicnil phcnoiru^on but raay be (<r«]Sieoi b hy«lier« 
HtiJ ucuiutlicnuL 

EnctAlioa (pmnnaatoata. l>dchin|^, lUtuJvimJ.^ThiB eovDnon 
pboiumrnom ntmU no expiandiinn Onlinarily nrgljgiblr. It am prr- 
sLvtenip troablcaonitf and chaiadcKatic aynptom in orruin iMrvou* 
dyspcptiu ■^^^■'■^ with marked nennuihenlt or hyttcrift. TiM 
tenn ^*^neumalMis ^* u pr>per]y applied to ibe condition of ejtiTmac 
diiMniion ol the ntomach by air swsltcnrwl by cni»in dysptptics or by 

GaMiic Sp«*ni.— Hfia«n nrmy occur either 4Lt th« cnr^'a or pylotus 
ami b^ith may Iw purely nervnu* pbcnnmrn*, the former almorii 
bvui^blj sOk the Uuer bclnR moai frc<tuently AuodAlcd wnhhy^iO- 

I >ThfV*r* HpnTtnl IjyHrifhfiVrm m pmmt in imaJ niunbm ewn to^ 



addhy; in Mxr tkcfc may be a tabjectire ktoUlwd cetiudan of 
ohotrucUnn, boili Ruy be («lnfiil aat\] ihc laticr nin> pn>duc£ 
viAtbk 9r rtcn rwcnctl pmatsUa tnd. If lonj^ continuectH k&d L» (dual 
dilKtAtiiyi. If the iwo cnndAif^na ttrr siniiilrviftuif (infarfjiMy nnimf ic> 
the ranHccd ontiiulenMi>n nmy be tridcni, 

GMtrU H)rp«ra«Uke«ifl.— Markf^d fcaciricintoJmni? with a. seme of 
wclgin, UfKv at Lumbfc ind wiihu Jl an oTgnnii baiiA iniii Uc cncouni- 
crrd ED hyilcrii. Dcvnulht^tm. cibnuslmi; and dcbLlitalinjc diAcotc^ 
KTHtital »Acl [iliyv(»1 iivr^trji^ii. priffoun'.l juuvmU. Hhtxk.niHl ftirvtJ 
or vditfiUty fuCuif; ior loDg iwriocb. ll may bo tttodaicd «ri(Ji mAikcd 
diffmr iftidni^MB conftponrliBg hi Ihi? tromjkrh onllin^ nnd i4 pnbably 
the dkkf cAUse of jrymptodu in hypcrdikiihydria^ 

GAStralgia l^u brm prtviotalj nfemd lo oi a miiutcd r«rni rrprcMiiE* 
log ill n!(dl Ji^itncr^ Aj^jcDdldUK. Kill (Ujiicii» ^onirii: ulcci in* (iinccr, ^!|hidii. 
the IQMIjIc CTiMA of toO^TtwIor iitAxia. ivfiUncbnic oriHo-tdcrosEn | 
iif Mi^Sna t«ctorL& A inw orunl^b of tbr fttomuch i» exceeding 

VERVOUS DYSPEPSIA tcombiii«l puinc ncunwci) — Th**p 
knu. of wtbcb tbc xtufjiJ ii iht nmrc dcMripliur. ^mcr ccriAln f^inu AiKuiwik 
ol ^itfric dimuft«no* pnflific ih mbyffrt''. friprm ivf fiA;ivJit« tytnfiSomf 
and ONnrnorilj ucucialol wiih ncEiuun vyirt^lraiii. sluxk. f^rivf. 
worry. Frank ncunuthcnm or hyitcrio. or. due U> nScx cAtuta i^uch M 
cbronic appradidtl^ p«K-it ifunsr. ind irovabte kLilT\ty. /( is fum- 
tUUy J fttfff j>Mdrofnf, Tbc tongue U tmioUy clean cr li^Hlly fiirrrd 
■od nuy ibow umc cwdliitg and laicrsl indcnuiion. When Itie itomacb 
Ucciplx llic friittciu QW) oontpkin uf r^trica»HiiU a ^ V*"^ " KEiwIiun 
Ifi th« «p(^^tnuTn. lu«duht.or» foiwol urfvlmE jirr««ure iir dulncM, 
nuuLcd vabjcUivc wtrdkiiCD aud }ul[niaik<(i iifui takiri}; fuod. TliL'tt 
b Inxibl w omg ijialcnsiont trucUtion uid (ifid^timtv purisiikllic uricsL 
■Mocfitcrl with pyraaifl «jid iirfliuing borbciiy^f. Diaina^ n^^g^^ 
uk pulmtlos and a gjobiu byvcrkiu may be cocounuicd. The ^rutric 
oontcnU Aie iiiUflllT Donnal but may ihow hyper-, hypo^ or a icmjwrary 
anat>dtl|. MctcnxhjSa b cutunion* and mttlnuLriUim fnaj oi iiiay a\>{ 
b* narfcvd. PtmMonoa ol tynpconu U iJU4 to sti unduly rrAirict^d or 
BiaaoloocniidB5,laiLic of r:3t<cTienUlaJidph>3:LBl)|>r»|.rrrrt:rrziiotiand 
divmioo aad a pcrnidctja and penvktit form oE introspection. Atony 
0/ Ihur osfcf ffqatirf jStUuU ftsl, iioiaticn. a gradwiUy inoftAttd 

lurac . /A« AVJigAi 0/ tsmprimi ^kyttriam iiaJ u ntfJt^uni oj uimmen 

[lail (Itf I. 





AKOREXIA KERVOSA.— THi curiotui fnnditkm duractericed br 
■b»oltite1oudMppTlitc And fnqvcntlirby«l>hovTencc«ndrcJcc<io«of aP 
food*, may follow pTOlongrdU8l£n|;(*i«riviIon"atfVt"),Uu(k,grifliftnH 

fasl/i(mi4. Inhj-BiprTcd(iu)ae»pedaIlr.tIicpBiiaiimayb«pn>touaifl7<ii' 
jemic. «il] ptomfily vntnil jill food ftdnlnbnrtvi]. oomplafn of ngof nil 
oftcD Hhlflki; olHltiminAl piuit And Ccndcmat. and froqucftdy pMeoid ID 
vi^mki bl^d, »r, if |viKii?d, tmiiattr ihr potnliil crUm i>f ulfcr. RnaftcU' 
Lion THAy be citn:mc and » faUl iiBUc U pOM^Ic i/ proper Eiral 
U not avaitablc^ Absolute nM, iiaUlioo, tnd firm control by a cobi| 
mirsc luid filiyiinjui will u»iuUy clou up iKc di£S<ioais uid cur tlie 
|ulicnl. One of Ihc mo&i chorDrtctistic feotQr«i U the «f«M<l «utai 
n^fflj/^f Li^ thf food ihnugh iisuiHy witff will he rrfnlnrd uid h^tftrOk^f 
ihc Mt ia one yf mcrr rtpiir^iluiuifi, 

ACHYLIA GASTRICA SIMPLEX (ftpqi^iA),— Tlis imtnilirfl 

wlmcni ur ayndiomc lb oI unknown c»uution uiJ affccb adults alroovl 

or quite e?tc[usively. So itmg os inirttinal dtgetUoa rfmaimr amajfttUi 

Jruf iv no symphmi are ptiidiurpJ jtl ma cuuniniTicxi iJ ihc t\amti%k 

^ TCT«Aia ONDpktc lo«> cl HCl «fid digr^iivc fermcnl* ond ft dimb^iM 

' vctttSoD of fluid, Th<^rr i« ini'> pain, tli^ fosring «tMn«ch £« tmpj mbA 

one bour after a t^ brcAkful the rc^dud coninit ia vcaLl but irlwlly 

luncbangMl ftnd Uckicg nucui or Jiny «jgn of ffimeaUtion, Mki^ 

|)ici>|^cally ont lind» linchaiigcil pnjtrid und sdvucvd slarth dJgcnkQ 

(ptykJlT) in ihc atjMTicr of H(^i. Fthlin|^A iml will |>c poiitiTe* Ibc 

lncrf«u^ I itKline u-^1 fiir undianj^il stiir(fir« neK&lEvr-, MMilil) U incmurd tt 

might be cjqscctfti and the intestinal {nicea compleic the pDxvnb tft 

advanced cftsn The inMlinc nuy bmooie the teai of irrfiattiw itirt 

oUarrhal iorianunalitm and tlie S^ar^ show imperfed di^ctfiionof Um 

protddo. In mch cue* tndicsnuria U mATked. In ftmuin« ciaople 

ar'hyira yutrira ihe inuci>Li» memlimnc is not airophfed but U ivsdUy 

bjand and abmdod, 

GASTRIC ATROPHY rachylfa gaairiea vhh aiTophyX— The fim 
term ia preferable and ^ouEd be limited to Uiok tancaof aoacMtprhjdria 
and Apeptia in vKicb atrophy u secondary 10 no other ailmrrT, such as 
caivtnuma 'txti/ ^r rrmobr, und c^pecldlv ^t» cjiaen piexnliag the bhiod 
plctiuif oi pcmieioui anamU, though thu bymptom may in eertiin 
tMt^ b« laclcini:. 
Pi«KliOtiS i» aJKiiDTed by the following fncion:— dyapeptk symptoma 
UiilftJinv ' ^^d even ^oIm may be marleed, in^fn^S ar>oreiia or avprakm to mean 
[may occnr exiiCtly as in cardfii^ma, but, unlike the latter, tbei 





hie lift 

lied. Intcstiiu^ tyoiplomi may mpcrvcn« and ihe UEUal aAcmumRy An«>KJt 
uanunt my gmdr The pkinTr ihcr U Lituallj nnc faipj^mlnf; riihcr <"r.mV 
cftrdnovu or f<midou« Aiucciui bui bckinK the lactic Aod urjd B<>&s- 
Opfder hirilli nn^ iht MdncM uf lii^i atifl dIblArbn &> riMnmon in 
caranoma. //i>A jcoie cuknnu tuptradds its vwn symptoms^ 

Sjttptonutic Uypochjlia «nd Achjiia.— To the forrgoing tnuH | 
tic idi!cd tlic jiuidy KcondBi? (limlnuunn n; n>mptc1c nbMncc rif IICI . 
uvl the fcrmcDtt. ]i BUy pl«y a pan in t^ie cftr.heiu of tcrmin&l 
iMiilirhk. <1iibnrM And Mihrrtulmk Ch nnr fftfrr{|tjnit in vvrrr chronic ' 
faUrrliftl (ciAUili} with atrophy i>t the imachlorhyJnc form of culHc ' a ithk 
utnrr ukd is pmml m %ef/^ of tb« circInmnAU. /^v^iiJ or r/mif£^ 

Saauorfi— A^Ua fiatriu nay be [a] vrn^lt^f^'*' or jtt^n4ary. 
(b> «n«d«<Mf mU ptimopf x^rtru 4jrapky vr (c) octvt m a dcpmtt Tutt< 
9ymdr9mv viJAobf iiidrAid niLJecthr ill»iurbRQcc LkUdjc oiMJ^il ly^/' ''^**' 
l^matrit larr f^ Uu f^aMc fimdirtf't tritlrit iniatimti irtilaitcnivptnitenft. 

THmgnta^n.S<t dbgno^ «TimiM Tht nuulr 'if HihrriTH' atm|ilti*.-«r 
xinpb Fonn until otl po»iblc pnmary sourcu hkivc been cjtdudcd- srch i 
Tbe alropZuc form b niRgvatcd by »ymp(cmt of cftrcioanuH cmtiatip or ^'^^ 
prcJiMinii uiduit^ but b4:klrL^ txrittiii uf ibcii jstsirL fuidin^^ simple 
Achyii* by the kitoeiUhiag lack at teycte «ynipioin« v^itli oa entire 
■iMHiuv ci pKArtAytk ngmu. 

DISORDERED HOTILITY. UypftnetUiiy bus already b(«n 
louch«l tjfctfi ind ii nurkr<t m hypfmcf-ilij^ and (irrwnt In ttfhylia, 
■ot&c oucs oi dUbctft DkdUTuik tape womj and thr Ipifaiion of ccittin 
dnig& Mch 14 pdlncajinn acd atrychnhic. 

2iolm immlUifK-j amy be iJuc 1o jutuid aluny juid the Icmi is Ick Aemtr 
proparfy a|rpli«<l lo Ibe >UAi prociueed mecbanKtlly by pyloric ^rui^ 
UcMMbaiin ihsF rastt ihtfTv may be idtinl tiyprrlrophy of ihr muKoalar 
layco oiad, Bor a tine &I Icut, ptrasl compefkaadon. Dibtfttion rcaulla ' 
from ihf $11111 at dther myattheftU or «coojri*, 

GASTRIC ATONY. "An ailanpt [*» »]jiuiily cUwify the vorfous 
coDditieoi uiDobftd wiih nu*cul»r iniuibdcncy or aciVAl dllatftt^n . 
of tlic tfKinuuii lc»d» lu cdiuih ujafiukn and it is tetkr Uf conaiiUT ' 
tk* li^KMk 9m4 it$ musttdaiivt a^tity at mm vt&nid tkt hearK Bitkw 
organ may he abmormailj ivfv yd ptrleiHy iM^pfteni. In the raw Vlra>k«u' 
of the stomach ikb bkrcMinif but sympionnlcja «indilif« b known ""' 
as MtffdtrifaJJrii- H'MJb AMUnnbilar/ fttviHn^ tn U<%tnM moior aiiiv- 
iiy ami nJanijan «/ At mtiHvhr waUi umsfU«i*i frv< ^lkmy ef $h< , 
t$fi^9Mk ami «f *n Mff foM <>/ 4i cArmncnUy wttA lu^ri U<M Xt ktt«M&\ 



■■»nitM«Ai1 iMtHnn oM*«>4r <f*sr**. tMiv* 

;if««] ■ 

tfA ^if, M« riMitatk and (/u A««r| orf aiiiu m lAdl J^f? 'T' '^ i*^^' 
omir, £|y MfTnurJ ^Uitm and hyptrirophy of Ikd muutr. ilr mutKm- 

£MtMfw«il Sl«ii£i Tbr jmt^ 
$Jkt u qviU COCt Mid hd|» 

Irmilidory ofiiuoiij even at 
Ihrprctcnt limr, Dbrrp'il- 
itiK mcKBloKUCria vn bun 
ftlT ti^flMJ villi pstiM-«lM7 

or mvd^cctt and ia ineri- 
1 ibk iccompo/iimeo! , dc- 

oikr biauffidcnqr.*' Tb« 
nuy txbl iHlhout mulMd tf 

(lepwH bill prrsiitnuf cf miuck rteoknca tovdnnM trAfc frvtM^ 

lUiaktUfH teirUiia) rj-rrinn uratEly Ihoug^b loM commcHiiy rrachiag An 
TXri'^itr U\tm iI^hm j^ the^me in )K'^[uAt mcthaniuftl utBtnHljon. Hiacr 
wc finil (hul in atimy (Tirisidcr- 
abb? dr^(re«?i of LUIat;iiiciii arr 
pojNblc vithoui ihi; c^rrmc 
BunJfal&tiorifi af gutric suuii 
u«i fcnDCikUtEun cntounltrci! 
In pvlohc ttcivwis. In Ihis 
Litt uyndishn an in slcrnusibHf 
(he nortic crifii^ oE the hcafi 
(Enlm myntibrfiiA or alony 
(irc-cxiai* there h [^iman^y an 
hypcruophy of Ihc tnusculu' 
main whiUi inay im u lung 
Time pTcvent mmiw cI^Llu- 
lion or markcJ aiasLi. Ulli' 
Rutely, however, either bccauK Uic atcnoni bcTOmr* inort vxirttne or 
Ifac miiaoiUr vaiknf^ |m<)ominain utct hypertro|J)yp maikcd dllaia* 
Ijun occurs with an ii>c7»«cd dcf^rvc uC myulhctii^ ud nmlctagsls^ 
OostroptoslA.— Any <a<c of dHautioa If nurioJ maj be WMidMcd 

■ad dltfteccd tuirMlt 

vrnvsn or tbx vrouAcn— aidnt. 


ChtfOfiLc or 

• irlril, 

^jrith Tu^dng degroi or lU^ibceiiicot (cctauia with ^»trapt(ni)) but | i^cutfi. 
^^piiiktd ftotli nay tadai wiilioiit dOoUlloa (BPitniplocu proper). 
Hftvbif ihf pTrfnnTti; facl->rii In cnlnd. one mty procmi tn dbrijGi the 
1 coiiiSl5on» UTi<Ic-rlhrc< chici hc^diL 

I (i) Atony <Fnytiltifpf*,"F»l»rtv*","mfllor'' or fiiciiluihv (nnuffl- 
I deBC]f)L*-Thu o»v«c» the iwn-^^jfriMAif form and aay be primATT. 
I seowidgy, *cute or chronic anil undAted viUi mfmly Umpotuy 
dfl»t»tfaQ o; ab&ornul di>laudbILIt]r. or, true ALJui'a, In rate ita^tmus 
#f>ilr. pf l tmlimm jctaX Matatitm £ta/n, ft coacUtkin of «pcdtl inpOT- 
tAQC* in connrcifrm vlih hnut itiiwiuc irlcrla-sdcnsfit. the Rrutc 
mJdctioDa «nd m»ior operations. pftrUcululy of Otc obdomiiutl type. 
CttroOtc dIftUtiOD of ui ntmnr £ciirn miiy br uvn In rtif rmpli^'r^ 

of brcwrfici or (Mhcia nbo arc 
groH Mitrt and hniy bt«r 
drinlcnb No otho dixaae b 
ri<ii«r in tMo^ Jattofs, 
junon^i nhifli *re htrfdiijr ([ii 
may t>f coniccnit«l)p oovoia 
iluxk. griff, wony. m^lij or 
phplcd oveotniiii cdMiiutloK 
dittoocs. ov«r««ling »nd diinh^ 
i^^i tpilcpi}'. inigniinE, bnln 
iQJury, abdominal trauinAtbnn. 
ffvrni»r (ifinl:)aixi>an(i Alcohol, 
ftnd fioftlly, ocrvou« dynpqvU, 
bqwric <irThosii, panrrrAtttis, 
cholclithiuia. chroaic constipn- 
tioa. dtforic >pp«niScflli «nd cnum tcuee jnirctkm ^typhoid, dlph- 
ihefM. Mcarfilinft. clc)- 

Tht SfniptM&l,— 5'Mfr/Mftw/j'. Ihc synptoms or; thai* deaeriM 
MwJrT MTtmu ttyspepia wiv ibol in fMiiy <4urf «/ vJvny £Af paHftU is 
l y mphm ^ vJWi ^ sCnvud* is emffy. Tbc »lij^lnt qitaolittca of 
food glwth^ imutlnanf ruFjifV^lAdrfAtlnittiia and ihrre is ^^jJifial^r 
fossljpfttion. Ot f a fl Miw Jy, oftc aoIcs oMmmuii;/ i^ijniiion And oflcn> 
itonc* Tvftfe ffwtric mlupmfnt urilh or tntboui ^utroploMs yei Ikt 
wtfto nuaM<^jJWiv«vryfyenE»nvdiiCrajAhitl>,<uf«iicrA^ frying 
J^dn, «r tJu hmtt^d #/ AJnfiJ reinlH^ ff^m 1^ imt^^Hw fi/ C pint iff 
vaitr. Thr pMifc oulUnc b u»u4lly nisHttiUy fittrnlH lo th? right as ! 
«cU BA do«B««rd and contnfy to ihc finding tn jlmotk aars» visibU I 






vrirtCAi. uuiaman. 

*!<a1nl i#t( 

|4iiiitf ctrv^- h afftjrent trttn 6 or 7 houn tius a intsi an<J i» abrK>nni% 
Inn in posiiion. Said excrwtiem iter ja^^ ?4i ) it ilfbynl vicl midhul 
|wJ will \jc. found 7 houn <ir moft nflcr Lhc Ric^l diiUkcTp Ihough «■- 
, 4J^v Abwnl i( the mcoi ^^f bttn rflomed {nvr uijfjbf. If tbe cue b« 
; wAlcbtrl from (]u> tv iIajt uuttkol v&f blkii^A ill liic ilxc vf xkt stconftd 
nuybvnolfd and, 1iT)aUTjj^ii0RM4'A^#<ilf^<ifi Nttf^fAtf»dr«tebitWt 

inKi Tvy irROtljr and air not ia iljcniicK«« diMinctiTC. 

Acute Atony,— Ttrri^inn qkijpsiHir nppFnaon. vftdroi dfy ittrii' 

|i«i>r5uciii^ vDRiitirvv;, Acitud 
pun. uiil bcichmfE fcllrmril 
bypcniotoni gv^'OuiclitCcn- 
**lftn. nJJd miruiiiiw anJ 4 
wnAk And mpid pulx. m*rk 
Jill ailmcm I™ often tccoh- 
oificd lltan it ttHrtild tie u 4 
cftnie cf acvm fllnm &n<J 
Tdftifvcly lUitcSoi (Salh 

Pott-ftcQotic Motor 
InnufRdency. -Wrtc nr. 

tual ^^ln;(.ti<^L rii^t mrft 
htt of nii;fctp lanri ut ihr 

difef f.aor. md«.l «t«»l ^,^ , ,„„„4 «..„«■., «-.»...H *M«. 
. iDlttCUlf nVpcHfOtAtf OUT Qi"" >"4 rtfitUob, *(ll|llltl> ifBd<t«d lamiiBfS 

' bv pmcmi In a liLauil 

tlomcch M In ihc ra>e o( ibc bean wrth vnlvULtar inconipticnce- 
Blt4>1ogy'-Wharcvrr faavK (kntitiirr oMinirtloit >if vhr JiylHim 
or duodcrum may cauM eaftric clUitattian and iiuufiidcDC^r. h 
may follow operation* u|h)ii th» itcunach, rluodmtim or ^EI-bUd4rr, 
pykmc wman or bypnUophjr. con^eoiul or acc|ui^.* i^^kdr ifHsm 
Uce p. »5j) and obstructive s<«r» nr ddonniiie^ Evnii^ tonvtscv 
pfnarrr jtrkem may pmluirr dimnk ohanntniAn mid dfaUlkift, 

dymptora*. -T%e rfmplomt 0/ mi^ H^rttHtf iytp<fina ir wTitj- 
Iftmfa firfdfimiMiM hut /niln nay hf frrutu ao^ ht wvtrt, panoEyimal 
■nd 9lknM by titttni visiUe ptrisiotm tr patp^U ear U ne t km» W, 

'on llic other buid. il ntaybc abtnil or nrplaceil by orupodatcd fritli 

*CcoKn£ialMto<flui9farcDtaincnrrtliankaib«A«ifUM!d Ttmccaaa 
<IH*.J.UCo<^rich.F .\-Kofl BDdW.Kam»v> laving bcmtnaf^MAe 
aqiborp atttnUon *\ihia 90 tbyv; aJl coaftnwd by aulap^- 


tfiipdUk oppnwion or ■liBlftukm wilh on wiUiout teodci- 1 

likCKUvd icseUBcv nwr be notcO &» «ttl u rhyt^t^Kal^> intvmiltcnl 
ngidilj. FtriMHr nij ot nuy not b;; viiiblr but i» mcdt moikc^ 
fhuInB punlul cdici^ if audi axe pmtrjL ot khunljr aflcr ■ izioiL A« 
In tbc bcBft, Itfttjt pcniitcitoe oE lUtiouc nuy oiuk Iom of muscle tonus Mwelc 
«ik1 (IbnJaudcin c4 pilpahlt ormlnbcilcim or vf*fli]f^ i^rTfifirAUn, Ihe "^"^ 
define of tfikftlAtion vuiy be iScttnainod lijr infl&tioci and aiiacuU& 
(i>ry prrcuHiM. pt^mimg ihf VAmarfi tvbr In Ufb, fliiomiropy. frstift- 
IRuiailialiOA.rbc crnrmtk.ctc. (accpL jjtsV CA4«xm ij/ iMle^nrrtjpotniitiK 
i* fkcnga p/ fMitirf may fw «TidmC *> in pulmoiiai)' cuvititA if Ovid | 
be jinwtML Sntaujianu #/ cwrw rmuAuil in [□Arkcdcduliu Armf- 1 mmv* 
uai tamimif m naffccd quantify, varying whh the dr|£nv ai »lenuiii *"*^ 
uid KtMio, <w jWavi l« lie /uJlbf iid«iuA nni rkiu^h ttii' Kin^-I 
dinner lie token Ibc preceding cvouog after lavsgF, and U^c cmtciiT^ 
an foul fcoeSng fprtk or cabbage or hydrogen iulphid«) ami if plaocfl 
tn a ftnnenlatba tubt wiih ^ucqk fEinhi>m*it liib<: x>r an Ini'CTlcd 
Ivil'ittlic) vrfll viltna a^ or 48 boun «lvjw at Icmu -S, vclame of di»- 
jtbrrmcnt liy pot ami llic drvelupmnti nf jtu^ iibnit. Imltwl fit^m 
fwii^ will abound if frna<ntaiiMi b« praaonL and indicate pcrBJalrnl 

Paul «ad VomiliBir-^ 1*110 is ywMc. ofUnabxnl aarcbslij^i 
dtfpv^. or i% ■cfcitiruifd by extfnw duuwm and opprvsucai. Ik* Mi*tfit»m. 
nmito U «a tAtotc drvcribcd. in4ky. of cMt^ii/e tjuoMity and ttfkn Vorr^Lu^ 
rvnfttiiu r/iankiRJi at s^ttftt ffm^mt wwuf j. wpccially *r<cia and thf likr 
ll fnqucTiJy >irpamnb«lolhmlaytniviMandi<»|Ea;ni] ubitur unri 
foul lo the tw(c. TV Miiftfai^«4'OMfrnW^>«rm<H/dJ^(^ fkcMtj. 

tki mkr&tapf liijwt in beaign tavi IV ynjii omH pvcitur; in laturr, 
th€ Bait-Offkr bnatU. Tbc lalrj adrl* nay be i^rocnt by ilicmual 
■n't w ieaoacotJc te«t>. Ifcc onoc ia aoiut, concvatrated if vomilinR l« i^riAc. 
profotr^ a»d K ^aalrk adtftiy be binh t> oficn ithallikt Jn ttatiiuii, Thr 
ptrnttfnt f^nrm* »/ Mb in ^cnli$jf tmrariaUy ^Mfift U 4vffdm4t 

Comptica-tioflft- -Aoiie aukftnioEkniion occasaonailr occur* wid ■*J!fJr'"'" 
even <oaa may tvavlL Exixvmr r!f<m<kni afmy not nn^ produce 
dr«|«piii, bMd^rCtfdllk «T faJpiution tjut may acHou^y cndasccr a 
Mak bMA. OatfA>-«:iocBnlHn M tonmon and. fitL^U^*^^ nmasA; 


uRvirAt. mAOXom, 

inicn»tiiijt condition kooirn as ^jA^ kiany tnar nipcrroiCt durinj: 
ihc pBAagr of ft MnmBdi tube, vomfdn^ or not pcrttittfon, 

jtirmt rttU primfnty nfen Ikt fn^f$iC4 ^ 44Uytd ^mftyittg of Ikt 
sMnaeh and the prixni^ and dtgrtt cj ttitiU «i WifatoJ by ptrriOM 
rrt^alhn cj jood re^ti^ and ^ermfnMive tMottgee, Funbenaorc h 
sinual mofhinlcal otHinnnffin recHrrnvf *md ar^oiu umiiimg. >bo«rini» 
ircr^ifrtcrtl And ofUn lirtdcckt fxid residue, morii^ rMU tr ^JkiAir 
pttM^tu hnd utually iJic framef of « pyhtic fiMWf tiiiit Uw dkg- 
no9UL In ifmoftc mBuflldcocy. tDorcorfTi ire vt orJinifilj '***B*f 
Willi cjirdiiomA, mtrtt rartJy vtHh f\j\oric ulcer or tt* fcnn, wnd iftt 
fdJinV t^i7n^cn£f niU vary vM Ute Miuolm /oiiurj. 

As Hu'ivA lABf frffitjpr 9ttd maUpwtie^tessJtaiS^uliiet mat ariac 
In tibiRmwlft t>Lif tn ifrnnml U ruy hr %M ilmt, vhflr mAt^fid Bluk 
cb&iactcrij»a buili. the pttsencc of Ur^c nimibcn ol ihi: Bc«»-Ojiptei 
bidUi, ihF cachcni. pmfoiind inrmh ami iht rrAltv ah*ttitt of hjdr^' 
cKlcinc viil ttir ui'l [omLiiirJ. mj nearly con^Uuit in aaar. Are «tMcnl 
or prcfmi in Ins 'Icf^m in bcrjfcn mcno!4«. in whicb tnoccorer, the 

I G«0tTOptosUi The KctitraJ 1opi>^ oC cnUTop1o«b(|x 767) ci»reoikB 
' con<^iTc« of which it 11 a purr. GMtropfosk taaf tost vnth or vtibout 
I diUlAtfon. inc3 mRy bv ^mpl^mtm or avu-mc tbe diHtndcr ol nnuu- 
ihonlft uirl ntrvoui dyvprfsiA- or. motor uuuftdeocy. Iboufh the Joilfr 
I if ror« jdtr: ^n iht MVfrer forfus. Auionipd the cigmnnonrr aynpAonM 
' uc: -ttibjfilirfl diflt«fi«h>n. Iroublrsome twrboryjEmi cspetiftUj if 
light clothiTtg or htrirla trf- Wfim, irr'ifrrrw ovi^r thf Mlir pknu, 
subjective nortk f>tLlMlioQ And, in ihc ^trcsoicc ot nnvMc kidaey,% 
' drftfcpng •cMAtion or dull pain rrftrrvd to ttw rcgton of ihc f^ffo-^itc 
jotiii itrliLiiicr liimhM rc^on. Su^cVMkm uoficn present uulloiir in siQe. 
The diBplimn<rft( i» deudod b^ the low podlion «f Uie tc«Mr cunshn 
n-adily <fetpnTtifL4fr) bv !nn»iii(ia. M b tay cobcMotl dlUtfttkiD. 

HOUB-GLASS COBTRACTIOl (frOxWar *to-»*^}.-'n»b rm 
ddcrmily if not CDngrnrta), mulls »«iiaUj from Ibr benLing ai a 
brjft; ttinulaf ukcr. nwrc rarrl/ frcm adhc^ons :ir scirrbtu. The 
tloniA<h is (tJvfdod into tvo latfml »«gmait< ^Qd ihc coninualcaiiag 
lining nuy be (rlilivcl; bqec or very tniflll. The tjrinplomei W7 
with ibc cbUBB and max «lM^y ■Jnulaic pyloric Ueamk ii the open- 
ing Im* imatl. 
DiflfDOsis, - tnddiion nlonr yriXt nurlir o^^l^c th« din^posij. The 
, foUovfng (Jgni arc viJuablc. — (i). Tbc rvtuin of only the tanjar pov- 


nisuuix or tuv ABDoanyAL oncAAt— ^^uniria. 


lioo of • But of V4UT tDtrwIuccd l>}r tkc tube. <j). In (listcnAion by 
ak or tiq^iiL if the «pcninfl k oanow («) thi* bulging and dulT [ivrciiuiun 
note dm; ■! fimt br nnlj Id the tardul poudi «iid tor be nppa^iU 
ifl the pfkifie pottkm. (b}^ The wntcr or jera nuf be httj6 or fcti 
to putt thmufth ihr nAmnv orLAcv cflpncinlJy If pmviufc be appllciL 
(c}* Tmomuniiruiliofi or fuorcocspr Cblvnuth and porridjo? method) 
will ibow oolf lh« oivfid poadi. (d). If all n<cov«rabl« wiu^ bo 
viilLJnwD luccuoioD niU be rvi<knt cinly cner the pyMc iocutm. 

ACUIS GASTRITIS (ffulTTiis ulamlLiUru bcuC&, tcuTr putnc 
csUirbp phkfpnoaoiu ffuiriLla}.— OvfinUlon.— Ao »ctiic (KUnpfc, imk, 
or phlei^nonous) ln&uiua»lba of Uic e^rfc tnucoA^ 

EtkkkkQ.^tnrliuTrckm h» ilfff, nrrvovi «hock. toilc (rriiania s-ach s* 
ptonAiD^ or incDic. «ki>hot mercuric cliloridc vicl potuaium tyaniclc. 
or. tf phltgrnooQiu*, pyjunia, ttpticvruL.. Uj? etaailiemnU. aiKi n-pe\y 
dinct infectkm. It ii most rrcqucnt Aitheeniremaof life ondinthuw 
defcffitalgd tnd dytpeplic- ICaccialvdy hot or cold drinka. owremiing 
uid imfiw/ai tmOkatiim s,it Important larion. 

If Oilild Ajutonj.— The Uvofuiary from 4 biniple caUutIiaI loflAfn- 
mitinn 10 nKTrj^a and tin|^ or multiple Abuirs^s- 

SjiDptotns. — Merc »ubjOcliie «ti|CJi( ui fuUncM, anorcxi«. indi a 
O^ted I0(i([ue ttitb or nithoul nauiKA, fali^hl pnin md gcniTal dyKpr[>iir 
iiunlJaUtkintmftyb«ibfeinlyfymfilr)nt4> Ir^thoscvfrrrfonnfroneffndt 
bi*dttdMbtptguiirkptin,iuiu0Qa, vomiting; and conatijMlba or dbrrliori, 
CDnplttB >attccia. «ir«ivf thrnl and a bunfing frnnTinn In i^k 
toiic tonus, prutrftlkai ui exueinc. Ibe pubc feeble, ibe luHocc cold, 
the cue tenduiff lo corot Mid death. $uch osei may occur in mtiti- 
(bmk and •leiivftit: ctluiu. 

Siosifich Coauau.— Mucufc u prMont in ih« vomiTui^ acJDciAlcd 
nitl) UiKJcl init BJirrda of mnmui mirribnine in Ifir toxk forms anil 
perhapa pus in the phlegmotiou tarm^ Frrp (ICI i^i usually abevm 

PrOj^aoais.— Rpcowfj ii prompt aw in FKrprbnnlly trvere (otic 
or pUcfSkonom CMCA 

CHROHIC GASTRIC CATARRH fdirrkok gAatHtifi).— A chrome 
C»ti.iiid t^^iVjiirThitiixt ol Ehe ^flaiik iHMOju. Etiology.— Tlic illicue 
mty loJlow an hcaxe ^iritii^ bul ia moie iKquertty nfi»ociftl«d wfih n 
moaato»ou« or improptr dictiry. chronic disraun of ilie liran. liver. 
kidnrys And lufipk i^ui. diobctcv and the anrmiu, cxrcsuvc unoLing 
aod drinking, \ht vtr of h^i^hly splod dittet^ mpM and eiccvuvr 
CAling and Imiwrfoct aiuiicaljon. It foUoik^ cctlAJn infcdioUA tercn 
a«typboid» chol«nvyitllowftv«ruid(h««xuth«nuta,and.lafltl<j«>A.\iatt, 






coAtcr or ttllalation ol Ihf «loniAcfa ilwH i< foUow* IhU ccrtjua cntn- 
ptitmting cur» nic htirll; dudngunhibk wa nidi, 
I Symptoms, Amon]^ tlie comiQofkca- orc^ flftictonre, Mcblaf, 
mrirtiiaj(-rh;iTjii«', mimrji ttnd |inti&p« vtmllinj^. iiyrcMlK fotti IttSr te 
the mouth. Tcrtip^, paJpiiatiod. <}]r«pciT&, coueh ajhI a (hxtt «« wiilik 
apjirlilr oftm uandat«d vilb > h^iw a1 rvplt^iion afirr n-«n m l^ 
maL i/oritMf cvnitlHif occitn upcdilly in th? duomc gRttiilB 
tiscocuklcd ^n^ili bcpttljc cirrhodt C'dfuikkardft' aUttIi''), Ceittf- 
pailon Jn !*ivte aact JillciTtallnit wlili dUrrho* I9 ihc nikv iWfr 
41V uHiiftliy rvidcncfi* of a poor rircuktlon. the Kinf^c to coaiod aim4 
nur^nilljr indriiiei:! by ihr ifMli, Add, nm«qu ErrliilifHiy b conn 
Mc/ked loa 0/ iniTf /(/ 11 ^M^ sten tvm in 4iaikictlj oKoodof 
where it u >uu*Uy due to ibt primaiy c»ii»e, 

StoimAcb Contents.— In advuiccd nua fret flCl is AtUlSiM M 
e^s^rtl. t^lii ijcxJiSy AWcic n^rmaJ. itftai siomcdt ivnUnI mnaUy fwnrwiid, 
mmetis ahtmt^nt f\tn h the eirpiy tfMDftcfa. sni] the- itfctvifiir }frmat£t 

DUTetCDtiat DUgoods.— All diffntritiiil liiaj^nais in flkr«tts uf 
Oil- nliiEUA<h i» lubjccl lo limlut'c^a and cvcption*. it bcidje oJus 
impoSiibJc to draw h^ril and ful lln««. juid dbranic (^uiriiic atioai like 
all ollim be cncounttird m its cml; ^nd cuiii[Jiuuii3^ funnx 
In the on« cue ir« mcM dianictCTUlic qrmplomft ond in lJa« otbcrbl 
with or orenhailowrd by ihf pifniuy dboMC. A cArmnr ^otfrMi Airii 
Mif /ntf^tf ^ijMi.o,r/drK/«<<iii£^ trnc£rm«j.JME<MJtfivi^ chJ ilifJh //CT 
Tw/urf d/ taJf/T Knd the niiirM fffUifiafLM. Axtfc «fM. Hcc$-Ofpiff 
ttnUli and Imtnof M XoMnOy preimt «b CtfOtcr, ^cA^ii) |pMiric« ioth 
IM HCt anj ffrmtnh, wui, in iJu namna, ikr nttrntrUnmc «r hfaiak 
symptmu^ ike mvn Irtfiui or tmi^ diUmh^Moa of S4*^U M m A m 
turd ihe ctsffftct of en akcvu ej mwrw tandty Hftmiidk it. 

pTOgnodE,— VArir« nrronlinK 10 ihe ctiHe. hlBiiy CMe* iM«y be 
fclUdy cured, oihoa ncvrr. 

GASTRIC ULCER. --Definition .—An uTc«r of the KBitric m«co4i 
mcEmbivit. imiaUy sbgle but oJkn multiple and lending to perior- 

Eliologj.— A^dr from flirrcr tfrimilnn nr tmumalnm hypRnddlty 
AAil nnlccedcBl aacmift appcv to be the mtM lio^onvti primvy 
fBcioTf, bm cbo imt <nuM i> not bnovn.'* 5cv. Abom 00% of ihe 

• Rcunl int«>lie4l»iMv indjc«t« thr raittoaar to the oocaaj Koaseh of 
prric«(ttv< mii4(uy«vii hui nodcriThjii fondiikm ibe^utivfiyUUsli m 

pi UbkaiMfVL 

DCIUUXC or TtIK AKPOMIKAC 0«(i vo — i;iCXN. 


cun sppMr in fcnulM^ Agt li otcvn rrn^x mtamcinly btl*rtn lh«r 
agrs ol fQ-40. 1cu( ofim 10 thiltltrn and ilJL-iIy iK-Twum. &n<), ihctt ii 
|irob4iily no htrrdilftiy ckment^ Ocoifatiim. Uiroct injury u Irom 
bkiWT. light Iftdftf. pcmufr; thr mfoiinn of cfimaivr drugK ajicl such 
ooettpaitoa* 4a Wd to uitfciniL irrtxular or huty coliiiR iinfi ihc UM 
fli livi|i*n(«r Imvl ait bnfb>rtA)it futnn. 

Vuietics.— <a)- Ccvnwn Jorm, of pronoua^cJ unl clcfinilc iijmip- 
tooutofeg^ draooiiikitcd bj Wr4cJi "pw(ial^c-<ly»peptic/* (bj. Tii4 
latoM /oran, Smgk or wtMpU ^ftt m^y msi Icr ynn and pefj*^' 

nl ukrn i-*ir! unnvDgnlxrd cUnlraJI/.) (c), Thi qcuu perj/irMing form. 
Ifi 1!^ UiCTC b ft raiMil ftiLmrwr and pcffi>ntlcin Uid ifciitti way occur 
w(th fnr <iT no fr^tuMiilary looC lynpioniK. (d). TJe/ tuiux ttfrnor- 
rUotk ^CTH. En iJiU the s>'Tnf)Ccwia arc umiall^ va^c. of brief duration 
4>r tamf b« OtMy ib««nt iDKil pcolw heraonto^ oocun* Other 
tjrpes otxaamicullp frnn tre apputnllj uiurapovunt. 

FUboldgj Bnd Morbid Aiutony.— The ulcere vary in sixt from 
iwvtMndonin nrrroiff nm mmdirfn^ fTnm^tniSinrbnb'ilfimrirr. 
TfMjr VT onKn&rilT sctftU. i lo ) in. rourx) , and dear cut urilli bttlc or 
no todonivD of Uw hate or Ihe margiTu, though If c^rumV Ihrrmiy bf 
invfHhr or sduous viUi Icinced wlu and marked infiltialicTi. Tbcr 
AK ofdiouily Mi0e, ftol infroqucntly iherr an from Uircc to &ve. 
itiy raidir > wore or man. /jw^'m. t'Jccr tcnunonJy urirur* on ibe 
po«icncv MfwcE of tk« vr^'^ <<^^ (^ ^^c tloDud) n«ar Iho Icwrr 
cumtiirr. frron iO'i5% ii* fionnd *1 ihrpflnrvn.t and ihririf rlimnir 
Oftfty lad to prWk ofaotructtoa and fjauic dilatation. They arc rare 
9l Ibc canh'a and grciicr cunrvtuiie- Gasiric ulorn ihov a marked 
leiKkflKT lo mur. lUftuUy nitkin an old acnr of a healed ukcr> and in 
«i old tdoct baa« true careiaoona i&ay devdopL Hraiini. Tbcy hcol 
liT fnandtfloft and b cuo of rattaulvc iilotv may jiroducc ddonnli; 
flixb«atWfcottr']|;UMcoalnicc»n but raoinoomnonly ■ pyUmcBUnoiii^ 
Ptr/itrptiam Perforatkin may rmdl m ^nrral |>rrilimifiFi demanding 
surreal tnierf<faic« ocd trading lo a blol IcrminaiioDi or, ndbcsiana 
may tfonn limiting tbe tpKud of the infection and ttvmg the lift, Many 
ouch cun of pcrfonttjn ifu uare<LijEnt<jc<r chi: oincniuni. Ii^ei and i^aJl- 

* Ja line *DCli ca*c aimiEji undrt thr AVtht't'i* olifrrrvtiiuii a \vuiiu ^T 
v^ bapd «ot had eiwn a syo^nm fA Apprpnn ^» tnHd ivd^nly with 10 
pofoi* a brmiintiayi m 10 c^vic ullage atul cover ihe Aooroi a tmall 

tftfayo't AKum \j<%y »» o( coiint ihoitof a turgtral dink la »hif I1 
UA typr wouM nalBally drifi. 

\ fiuriv 


Eru* I9ii*4. 

Hatt M 






■ ■liri. 




bladder and the ivDcnts may be InroTvtd.ttnd.vufh Adlnvians coni- 
IjlicftLc & dbic«J plctufc and letd t^ mlicxkcn diftipwu^. The Autbor 
tiuobMTVttd (un(n wbich th«g>C4)b(lderwu involved, theiyraptomi 
cjuctljr ^muliticg gidl alODc«. Tbc 4cutc pcifuraliotu ur 
(firect wkI involrt Ihe gmt^ntl peritoneal oivity. Ob>nm 
mty rcfuili b ihr dimuk- funni. subphrmk aksrEs «iid pyo| 
ibom beinjc vtracttmca obacnccl and fisiiilouj c£)mn}ij,niutlion ciAy bivoi\t 
inula far <1l«ani ir-^m fhc oH^insl teai of tmntfck. The frerpwttcy 
vf pcifurulioii u uauaUy stnUiJ f tj l'> i^e) lA cciteln)} t<M tuj^* bcinf 
neceuarily bui«d upoo oun yidding iK>«ltiv« syropiorai or oomjng to 
■utoiMy. uiii of couisc crarning the doubtful or Urtt} caao whici> 
no doublp ouinunibcr the othcn. 

DlagnoKU.— The dkgiun^K of f^rlc uEcrr tfiUUrgdydeffeniktqMn 
tbeconamcaccoflhcoldtclimdof iivrriptvrnA, /oJn. iM4i/lu^ i MAnwj i*. 
v&ttiUng end k^mttrrh/igt. yrt In mrty Inaianm wr mr^ and rTin>g< 
QDzc caHy. liLLcnt,Qr Urral ciuc4 which Uck iJhcM innkcr Hympiovet^* 
A large prDportiuQ drmaDJ the canful bolandng nul ui^vu of a 
Urge number oj foctora vul j^UU pnj</ratitm *ri hcfimfwh^z^ "uy <Ktm 
in C4ic^ Ufk4Ch kact firpinottsiy iatked Uk symptamA nfitaary h tvtn 
a tffMtMw diaputtU. PlArln^ ihr dirtfTraJTifng f«ciorft MBmrhtl ta 
the order of thdi dinicftt imporUccc nc b«vc (a)- /^Mn. (b>. ZMiar- 
iatd MuUftust. {c). Stntftrrki^ge. {6). Vtmitiiti. (t), High kydn- 

(a). Pati]> TJh: <h&racicriBth.* of rht: pain uf p^tric ultn art 

Iks faking of food and lr> speciiLL fonru oi uigBlA. (and). /Cf 
IfW 0/ oCifiTcnc<- Being dc]tcTidctit priiiuuily and cUdljr upon 
Ihe incrcftfed secraUdn of hydiochbnc add incident lo the dj^oC' 
iTc jtfoocw* ll i« tiol aa a rule ImmcdLatc bui uauaQy brrciaMS 
Mvero an<l crta cramp like ia fnm half aa hour lo two hmua 
mtitT eathig aiul cpntini/a unli) ihr at(ir]a4:h Is tmpCied by vomhnift 
■tonukcb wuhing. or by the naiuial mecharLum. In totnv ituIadccs 
dfatreu diDott immediately foJtovinj; \hc inf^rsiion of vny hot. oeU 
<v add subatjinua la ^gnlfiout. Onlv In cjice^4loiit] cMca. namelj 
thoM ol <on1fau9ua hypafvacretion d^ vc bnd [lersWenl pata oi a duUcf 
danciu bcttrecti iiKal* and oqjtxudl^ ai nij^hi. This Eaci auggoMa 
tke importanoe ol atreldiiii^ and diai«nsioii ai wdl iB paruuLiii in 
the produrEion of a!>ea. The hctOttm erf ihi* paJa oefesatiily variea 
*The diaraw b ottfn one of utivmdy liow and inatdjona d> Wf hp u lam. 



pDmcvhot «ich ihr poriikio o( tlie iklcer and of the ikprotdi itxV. being 
«* ft niU bnvr in tightly bued womctt And m ctscfl of «ciasia ihAH under 
OrdlnAiy ooadStfoniL Aa fivr^ivthn of tht' «lamH<:h lir^ ti) thr )pft iif 
the U&c«-«Jbt. uid tiKiVt ulocn arc wpon the IcSKr ruivaturc. one Mno/i^ 
llHdf tilv ^dja af^dr.ffHTf f^wMrwi^^ jfj,if ffi U/ U}tfl} thrmfdum fin/ 

ilvell*tnc«fraailjiACjftorarfertfHd(f'fTCtf^ Im iii fypkoi lorm itit^bfff- 
fiif ^^ saoki^ ^11, bui U nbo docribod u bwwJn;. JfoA&tn^, ruXfinf ttr 
ipran/ JJJfcr. qviU rnqgenlljr f«lt »1 llic btek.Kfnctlfncs ndintm^ upwards 
lo ttic Rgfuo of tlir riiotilder bliiirs. Thin lyjiirftl pain ittcHrn n*i>1an<l 
bj thai of 4 doUcr chanLcttr and a sui>grstivt feature nhen prumi b 
pte ivlief mennpvijFing <ii9ngc» in ftttimd« both io Ibe prtaence wid 
ol adbcvTons. Ina<eAJc oif pttin id rrciunbcntf 9uy|aU but 
not pRrt« a kiioQ ol :bc j>Mlcnor wnli. and a dtnilar ^ferenca 
Id the laif/nl ^ir pri>iir ^HmTitiriMEA rcj^rcU 9 Itskw cif thr pylorus 
■BUrior uttll. Loc&lind t<fidtrQ««». The importance ol thia 
pgri Ues In the fad thai a riittinrilv drcunufiibed superfidal or (lr«p 
kendaiMaa, ^lUn exinmc, ia uMiallj pmjtnt and corrcjpond* clnscl; 
fe tbe area of rauunuai pah). It ia luualL;^ epigastric but la a tnfle 
|ll» lAe Ir/f of liie median line aiit] fi^ra^md aa cinitniAlcd will] Elic trnJcr- 
pas <d tB"'!^ hypemihtaia which Sa diffoMd over the whole ouiLmr 
bf even the taifiatod atomadL About ) cf thr aum ahow a tharpJj 
iDcaltscd aita of aupcr^cUl or deep iorW tmdemus. often edreme. 
^Igbtlj lo thr kh of Ihc loner dona! npina (j-4 cm.)*- 

nci^GrrbaKc-—Ilcnu>ntMge which OGCijnmt lot of /ttifXflJMduken 
la, ir brgc, sJriAj« uB»dtl«d with vomiting and U 4««i]y vaoe0^ia*d 
■a of ipstric on|;in; but the amallcr bcmunha^ rapidly uiidcTKu «uUi 
Ejva changea aa Co doidy iiinulcii« l}ie inuU dark cbia or co6«« 
id partidea o( cwthuNna, Furrhpfmnrp, st^ttt or rvcn fatal 
day be due to jcutiic craaian or hepatic arrbosia aa iieU 
■■ ukvr. The ttoaU aa vrll aa ihc atomadi ocmimit ihould he ra.rvful]y 
fetcadplcd b«lort dedarut^ bemoTTliiifie ahacni and concurrvni symp- 
tocna br casrfuUy vaighed btfore a £rank h«m>rrha^ U u»cnl>4rd to 
nlcEUiiaa. Emt m mt a ha mr r ki ^e may bt retfr^^fftd frpm and bul a 
p M a ff jii—ifty JeiiwdtyJWffwi U. VomitioK- Tliough oft^n couiddeat 
bMi a palahil oUa vomhtnq viih or wiihoui hrmorrhAgp h far 
pvcn ccfttUal ocd nauaea ia ttuftt vUca aecii. U prcseni, II ia u«u«Jly 
btefular and in any ffrai n-lirvn or ino<lilb'« ihc paEa, 

* KifTly ii a loliltral of on Ibe i%b| aldF aLonc. A Hcood bodp nuy \jt 
f^ttiul owakipalty a4 llic Icvd of Ibe fuuitli auJ £f ih dunid i\ucii» 












IfTOCAL &iAfi?rasis. 



H7p«TncidiTy^- l^^hhyIlro(:hl(>ric«ridv^llc«Anca«ulM(Je>-45%^ 
Dormal t^ufa pruUtblv the n^, aulwidiiy ifac cxccpUon.* Aa bjrpcf- 
chlodifdnft ii ft comnKn oonditioa without idnr. to Ui«l tlw flympMn 
ivf^ ImportMit U only cvm6vnidr»v, frrrrthdm decidtd kypv mi^fy 
jpM9 ^ i0 4Xtttide ukef, and AaOie 9dd u almf^i tttv^hMf «h^. 
(SilbAddtty Ui WDAlly ftwtrlAvH iiTiTi i iiiiniHi iihjjt raitirhil pMilllinf 
cctuitt.) ThE Tooniling; in hypcTad<liir ^ ihwply add lo tfcc pttitfii^ 
IUt«i and it muM b« tnnFmb«n<l \h»\ %ht proper ri«mmiii4lioa «J 
high bydrochkiiic tbIu«« »twutd be baaed upim 4 teal tlinncr milm tluft 
tire mcofpt tMt bnflkfjut and th^l the •ound mud ool b« titvd 11 vidnt 
fVEfhInic Ijc induccfl nor fJiAitly after n hcRuvrhftgc^ U 
prrMtit » i>n>pcr i«ti mctd m«)r be uken and thiu roeiyrercd, ibe 
being ofTvn ^uffiti^nTly w^lL nbsrrvH. 

G«i»nd Djapeptit Synptoins.— These vn more ooniBOQlf 
dated wiih rvying degraca of aciiuJ pain than it unat in 
altnicuu BccnuK of n'mnol or hiich oddity the dipaliiw H 
ur (ifuti more rapid ih&n nnnrrnl, the loni^uc friattvdy ckaa 
apprtiic uficn (crxxl. Imlmsl tn;t knorttla U«n ccccplioaal aympioM 
in giulnc vXoa, ImufEdent QutrilCon being onUnArily dtpcntlenl 
the pitH-ni's dmd cd the paii^ ood diftmt atirrrJing the ingestioa «C 
foi>ii Aomilft. Tlic Aui^vr frcLt lliAt too lit'Je ^trcA» b kid W 
wrtlora upon th* (requ^ncr o( iHJfi«to*Ve aihtmia xnd nj^sudu ii ■« uoe 
of the more EmpoAftnt of lb? fljboMEnaie facmnln dUj^osia. Il it 
probable that Ibc anfmu of fsuinc uJcer in some cuca nntedAica lie 
jeiian. pRdniMy tnvllM. and. imda to p^rprluaip II. la <Hhm as tW 
result of pcraijilcnt or rtmrrrai hcmorrhnte of YAf^dng dcgroc, it 
Buznei Ka intractftble though not citrcfne »econduy type wbecha 
' BUlDccdnil vr raBsnfucnL AfjirjW intntaahU on^ntia e/ lAe itcmdarj 
I typ9 in young pnaone attPtUtfd infA gotfrk ^itMurtmna vtd 
tii^i jtcidlty Ts suggrvtiv^ and, vhm afinnipiinirvt by cvtn 
Idvitnci of peisijteQt locfti paia and tcn^Icnmi v'ill jayify the iosl^ht- 
I tion of m^dkai tremment ander » ipnuiiirr dUgiuuix. 

Differential ViMgnotU^—SiPtpk kyp^wi^ h oommoiity lemp^ 

Inuy. intermLitmi. dt'ptndenE upon known ctiolo^c futon iiBd wualy 

.ticks airiTTTT pajn. loct^ted lendcrnoa and hanonhAKe.? iSttMt 

kyptfititJusM not only involvvf the whale stonnch outline bul t 

* Accttrdiiv lo *cuny ob^ t TPfcei it vi n mon oo aHi ffl svmptwn , 
Dolled SUhta llunln EuAfpraneliiiia.iht^ nvrogebotiJaeidilybeiii^l 
■00 and Ih* rtM EMid alinvr t.'y 

t Rare ima&cA of rtcATloui nvuiruaiioo vidi hypfnddJi|r oervr^ 




d«£c>d with cliuiiiGlnc ncvretic t^mptoma G^^ric trajit/ra olTcr Kmi 
dIAciilly In maAy in»bimi but tre ia gment to be ttitlinf^hH 
bjr a QHin diSittc buruag kiuvUiqd upon itic taklug of Tooil. ociuo! 
p*m beipg u A rule ili|tli£ ct fthwnc or m nay event cominj; on 
Imfaodkcdf tv iriihiB hall an hnnr of ihe Ingullmi of food Prrwure 
iGDdcffiCM b unudy kckbjc aatl hTpcndditr b tbc cvccpli'>n. The 
wuh wsuiof lh«lMiiD(;tnrw4choonc^ftthrt<U<if maciHurAfrinbrfiEi«. 
bm llii» mar occvr In ctber coaifilioni. Fiiully. il mixy \x »lcl ihii 
Iraviiucli » > cne of cvocJeat 4nMndi much the •&»« Imlmrnt » 
likcr if rccognijccd. it l* not nrcrstti^ to wt-ish loa c&rcfuUy thine 
diflefCBlkl potato which nuu^ the writer b<lit\«3. be taken turn £riin^ 
taiii, Ihr pntttta of ctltrlnrtEnn hHng In mnnj fntTAnm Itm «lritnlir snd 
aboobatG lh«n ttx hen Lud -ioiim. 

DBOteul inc«r.— ThU coD^lior. obvnirt and fnquentty onr> 
lookadL » sugxciled by tbe ft/mptomi of ulcd altctKkd by madmum 
pAmt4»lheTJ(^oftlieu«dUa£Dc.«ith ibscttccof bloodinUievomitu* 
or vBDVVcb iruhlnipi u>A fnci^uently Its pvocTKC In tht «Lo(ik Hy|<^' 
wTdhy U tbc txtfftiim \n ^ao6cna\ ulcer, 4ight jaundkc ia noi unconi' 
Bioo anil Ibr pain accpfpiiyiTig tlip taking of flood usuilly bvronii 
jrifcra ool]r alter nro of tbnc hourv /if AeftfWH rJ»r ?/ 'A« pylwrus 
end Aae 0/ li^ tfjMdtfwm an abioluic diajpiock it luuaUv imjioatblc^ 
ConsMflM tf/ (jbf dtfModi prracnls litlk lUflTiculty uvc in Itie mre sub> 
add Uilcer cax* or tho« in which a catdni>ma dcvrinp« up^m on old 
nktr baM, In vrhkb caw lAr sympkmt of Urvr a< /EriJ ^jirmtno/r 
4W or* gr^iMUf stAmtrgfd in thftst c} caniiicrrui* The pftin of 
caneo- u ovdinnrilf lew Bharp and pmo^^mH morr contintioiu, ihr 
aipet&daJ nr deep lendemeu ks* in (Icgm^ A payable tutnor mnkci 
lea appeansce in a tar^ naajority «J iho ewe* tnd u utuaVy rifd^t 
iUoL ftoUd and Cm. whctraA tn nk0-. sbyc in pylurk fuc* nr uhc-rc 
adhcBwn asd perfbcation bavc wcurTrd.Ef any tumor U felt fjn (hr m^U 
El U Ihin and diMvEke rvpr«f«itng ihc inrlimnl uIcft h^e. im\ vamWy 
lefi nied. The nutritkia vifen [nadr in cardnomEi md is laaod- 
tMd with tbe pn>pTWfv devTlf>pnicnt oi the well known ca<hecli< 
apprarahiv and njunac fAJi.T& llrTnurrbaKeianioietcnKiMcnllyof iW 
i>nalngl)pr,«pp«taiint; ai"<uSr« grjtvid" dctritiA« m tho vomhtu and 
sCoimifh wruhn^ thi* lofaiion of Ihi^ pain is UfunUy 10 ibr r|:t]l nf Ihc 
median Line, hctxmt of tie pcecbMainAnct of cacioea at tho pylorua 

■ Il u fiiltnt thnt thror art ^1 (eruio prrludi wndlaj^^Mkable, vH 
npcalol rx^tamthtnt wDl i&m Ihr iiadiuJ anii«stiilk4ni irbmlifon See 
ai>li^p «7<- 


' PuulZn* 









rcre&b with tore cjoeptlon;! «□ ab^catx ^i iitr fc^tlrocltlodc 
piCMQce of Uittic ftdd «n<) m a nt«joritj of iiutAom :fa« Bou Oppler 
hndlliM whkit Ii (l]lTi:rL-nIi0Tri) frnm the iDoiilh badUiui al a idmAit 
l77>c 1)f Mcinin^ ft miiuni wilh Cmn*» voluiJoti. which ooloa the 
BoM^pplfr hfi)«n j^ml !u imrxTVpnAlrir h)uc^ 

ULCER WITH ADBESIONS^-Tbc dUpioaut^f uIcctwiOi >dht 
aooE depend! UrstJ^ upon ific gratnl tjmploaa of ulcn » *Ul«d, com' 
blncd Dv!lhthoaeiicfcncdli>itdJa£cinoiKDi]Auid, somrtlmoiL a soiMtkft 
»f diMAxiriff <'r pulliriR eifrcTicnccd :r certain movemcctA of ARiUldM. 
Vrfy oftm a tunicif ms> lie I'&Jpntfl but nutr} twci* ofTor nonf but 

. bdcfinatc or muTcadinfE aigna. PCffontEoo- Tbc »ymptom» ol per 

I faniion an them of turgiod ihoric fucceecf?^ by fytVLpeonu of locsl or 
gcn^nl pfritoditia and occtmng m cat£t tirdimuf^ gwmf « kishry of 
idtrr. thty arr cufati»ll^ niigkat and need not be forllMr niaiirliiil 
Ilis ei'idratthiiSgaslntuUtr Unci a s^ieirymfkrm distaste ^ovmihm 
ofl«n n-qujrt* » cvnfuL mimtto of frcbabiHtkt. and a thorough kttvml- 

I edgp itf all of the diognuUic facton mvolvcd Xo datiht am immmm 
ntatibsr tire m-riii^'led 4ni go cntff iptmioMtmi hnttins^ ctrtttijUy mmt 
du Dj taddtn A^iorwM^ge trr ptriantifiit Vithavl frnintt rt^gn it tcm , 
HdviHtE iIlcm; iwoi III iTiinci. the aulhur tx'llcvra ihal nrlvrcTcr an* 
rmKiaabk prvbubillty tu&U that AgivpncApeiBOnvofukcr. the phjv 
Idan ihoulil nol wail For more llghr bnf ihould at oncn tntdmtr apprO' 
piiale nKdical tmtmcoL 

Opsrativf Cat««-— Thr^ vndrnfy in p^Tfonn radii:*] niffilral optn- 
c(<in» of the majuf type ai a priiaaiy nicamuc in )iii»\tic ulcer is to be 
dapbrvd, &nd mMty such iratca a:« undoubt«dJ/ llKttr of »iR>|jivcn>«ioai 
Niafly trvery trta tven */ fPM tjr*r thvtUd fin$ncerv€ frvhn^ mt^ed 
tftaknetil and iht katk be lecn'ed for the obstJOQl* nod recurrcni. per 
ritfrnilj' hipmoprhngic-, or pcriomiivc cntp*. fnr ihoic auodaird wkh 
adhciJaiu which lend to iotpalr tbc health or pendslcnlly anooy iW 
f4ilent. Ar. for acitiJil nmosii- 

OASTRIC BROSIOffS.— Under vmov* oooditkica vkI iniucocn 
bcth Ioi:al and remote the ^ciaiTk mt)cou:i mcmbrvte may ibow a sur- 
piling vulncnbdity, luid crwimui arc i-ailJy produced rtijiaf, from 
n pin'i head to ihc ^« of a lentil. Variout namc^ bst^ been ifrcn 
to ihk condtiloa and F.lnhom haa iattritwd i< aa a *rpuaie dbnacy 
but In view of tbc fact that it may xcar under piirdy ncrrou» icJu- 
mcaa. En chronic gaatriiiH, achylic putrica, and firolobly as aa eaity 

, »Uee (jf gamine ulcer, ic should hardly aaytl bcdlgnl£rd t>lhaiciicDt 



BymptotnK-^-^Tboc maj (1oi»::I]ir sdmuluU i^uic ukcr with cnn- 
Menhkt or smAll h«ED«:TTCk«f^ j^n*! be ccUrcly nmptomtrt* or blend 
wtib the >)nnpinm mnifkln nf the TnrioiM dbvMjon Jihovr mc^ntlnnrH. 
In tfcoie <a»a ftimolAlloK ^^^^cr lh« p*in IJ uttuttly trst inknse, uid 
rwMu AM MriUi* but may omiinn* until ih^ ftion«ch it«ntpty. SumnKk 

BJod mm am U Mvofl^ prmml in Ui« vcrniitus c<r rrmovcd cooicziis. 
Da'minjdhni «/ AjdhrfJUMc tfdi a ihc rule. Occult blood fn Ihr k<n 
Uid ili^t ilun Ja^ of thcltomNrb K'OJihlnjfljaiccoinmaii, Ut^ froptr 
^tatmmt rrtavtry U unuffy putmpL 

COB M i m t. - DUTrrrntiial diA^oou 19 iixpoftvit only aa prevcrling , 
WUneeOMiy r^peniioni u th« inrdif:al Irenlmml of th« two on<^lio(ii 

CARCinOMA.— Etiology.— rfAil>r^p»njE Causa. 50% of ftll 
ciMl of aiclnom« in the innlc uv leulrlc iJid Age mwketJtj aifecta 
|h« ntlo of faidikMt^ S«cb pi>wlli« ^rc r^rti tmd^r 3a but urc always 
po«Iblr> Tl h ttmsi fmjumi tn m:a\n. and hrr^rlity i« a facK^r of 
cDbaidcrablf importaiKc, The kv o4 a prt'Ciistiiig goatnc ukcr occa- 
ifaaallj undcTgDci m:i]ignafll diftfifie, Intun^aiuam wma m mra 
SaaUDOc* U> b« ft ham and bodqv auiboritit* by much atr<» <in 
Biontel worry or atrain. bul ti la probablv thai lhe«c ran^liliona cxDrciao 
fiiilr fnflu«ntr. 

Horbid AnatomT.- Cbccft of (be stooudi it touaUy primary, 
ibou^ oooiioiudly it b ^eMttdary 10 canoa- of the bru^, uterus 
o« odttt ticpffa^ The mo«t comnon gvovnli I» the cyflcdricd celled 
adino-cafdnonL l£n^cphabrnd U n«ti In trtqvcncy. then idrrhiu 
■a d ooOoid. MaliiciLLTil i^ruwLlui uf ihe stjitiatli ur frc<|rjtfiiLly tlic 
^^Bpicc of mtlavtaafv in Uicir advanced atapts. Such ttimon muoJly 
Hmiop ne&r the oHfiors a«id mnat oommonly at or near the pylorut 
(9^^)- 1^ >htt ^uacioD ihcy lend to cauk o1:istnict>oi] and dllataEioo. 
Gnvirtlia U the cirdla (^) arr- ofien afijUHiuevt nith atrophy and 
occukmaBy maited oi;pbavcal UUicnsiciii, TEac atomftcb may be 
gnatJy diipland aa wtll u ditoUttcl in th« cast nf pyloric ^wlha 
unl ftdbetioiiA may obacoie aad cumplicatc the dimc^ picture. Sudi 
tiinon ue ordioarily^ however, frcdy movable and may in rare bstancca | 
be foucid fn ahnoct any pari of tlw righi half of the ahilomen. | 

* The nihor nrulU ■ ietiftii* hliifld-'f du'* tfi ihr Utt ilmt Ihr f jt rrttir 
youih oi ihi* paileai midr Mm loatb to actefit what ahoutd hate bprn poii- 
livr crldnoE of maliffnaai gr>Htb; Deverihelcaa. the dEaecae b ran under i 
the ijcr of JO. unojcDairm uetnon lit* a|9 of y9 and 4^ moat fn^vuenX 
betvccn tbi af^ of 40 aod 7a 





aiudrvalf . 


t ii[fini<an 


Com turn 


Bfinploiiit.- Cuniray ruch an Advanced tupc of < K ^ Uci t iim a' 
vithouf (>ru<iud>f; ^ay niv-^kaMr tvmplomi Mic Aote n»adi cvi- 
ilvni bjf euntinntinn of th? siomicU mntrDls. OnllnArilj our fimli:— 
(kV Dppe^a. ErudutioQi^ pravufc^ twnvilT coated toopic. EduI aok 
innnniTth,ru-. (b). JVofrr^mv Ivo o/ irrtf Ar. (c)^ Utvkid ptffresikn 
im^ntifMt 0t ttrm^th aitd f^nrji*»- (d). Aim. UjukUj i|alL 
boring and •ooWtthai p«niMrnT. ThiAcympiom li prrarai In 
nJI uian, ii UMMllf qifluUic h^t may be rcfcrrrd, cs|ciaQx If 
fioiu cjud. or if the aomach U S'**''X diiplu^l acul. si niv inMucn 
nuy be w^rrc jmd spuinodic, rmimuJJ may or my uot be pns* 
oil <W M HjMJ/y HffJ fUdrrvMe. It ii nioai luiftfvi in iKc f^/Af cpcfpA^ 
irtiimind nuiybrnBUKfnirH vlih utHlrmroi In (he lowft ilnn&l 
pottieHcdy* or, atitcritjrfy. at various \»>in\i bciweca tbc n 
the ambiUcuK^ 4r>. .iMfnnid. Al ftnr nwd*nil«.ThhmstyUlrf brraw 
ntncmc^ luuaJly pirsrnring a de&nitc mtmd&iy type (are tgimtmm), bui 
m &dv&AC«d ukcmii-n; cva thowtng it timci odrrnw fr*^le« ditfclr 
liitiulaiiii^ tbsc of ftln>phli: lutriti* nr [icmkioDi nnBmk. Lconcy* 
tons U osuaUy prtarnl in mcUaitjbor npid ulocrttkiii^ (Oh Pt9tr~ 

50f^ £/ Uit advamrai mtn art tiritrnpatti^d ^y 4 w^aiftcM Jrfvr 0/ Ar 
'AaAV fy>(.in arc iniTiuKca ftuDcuicd vtilh "chili aaiI kvctp" dur picii* 
'mbly, li> MpiK absciTplir'n frrun k& ulcrrating tiuiicv- (jO- Vfjtarf 
• ng"J Thr ijiity fm[uniui1 ivliury AncUn^ arc ImdJiaoHria. mHtk il 
iiMuHy jrrc«?ni tu a noarfced J»grt«. and, Uir diaja>'f»clkn. u nrpofiHI 
b/ thi? nnlfaar u rouln ailvancvd vaan», <Ti), C»4iiit trmkwa 
Marled tardiftc wfokncaa ind edema of tho lower fatrrniiliu art 
uauaDy terminal aymptomc^ (i)- Aiiirtna. Tbk n uuially niufecd 
and often WBodaUil nilti rcpu|[naiK.e. r^fctuUy lovarda ml acal* 
(JV A#MM. '£fcll is pFcvmt in a gr«Al nujority of the c^ms, (Ii), 
Vcvviifiif. A aympliim prcarol ;ei 90% oi ihr (lyLiiic cvjib anil 
oociurioi^ uaauUy one or moit bouis aflor maal& It la ordvurilf 
occailnml. b;jl m.\j h^ fm)u««i or tvry nin^y alntoot rmtnuoniL imd* 
mK lj> rapid cxhaustioD and dtaih. 0% ntmarrk*t<. En from }o !■> 
jc'^ thcfir u T«i>f[nuablc hemofitLif^ and if undoublcdly «cur» tn 
a niutb Iai]£rt pviliun- In all caMaof !hu»pci.lrd lantcroUkcUoinadi. 
tbt siwit should bf c:iatnin*(l aa wHl aa ihc vomhva aiul atomadi 
cnntniK Brrgbi red ajtrrial blood in the rumilLia u uaaaual^ it hong 
otfdinoiily in aokaU dail grvm:^^ r^nii cf "cvfkv ^iind" t«rticka, 
became of tht aetlon otf the dlfirttive juicra. inii. Ctdreria, Jn 
adwicrd caxs the jkb I* pdle, rdlow, inclailic 4nd ill tiTtinxUtauK 
lol tnalnsiritiuo and loti of weight, and ofua iLom aniaa of p%- 




mcaUliixiot pi^BiCfrtclropliy. h cariowcuthy potljir i» uf Cpji jjttacjiL i^^iUd, 
am) ia move or 1m chancicmiic Mn4. quit* w ri-nkin^ U the peculiar 
fidsl KqirTAit'ii «a nfrirfi mmmilfTrd in ih«c cws ihc paij«nr 
«pf>nriAc<*<i>niD^ vixiooMitldqirtM«4l. (a). TitfiirtrH A p«l|4blc 
lusor aisy be found in thnai 8c^;^ of the oiirii. tnny orrupy 
■Ittuvt An)r pwlm anl bcfndy ihuvaUc or olucbtd by adhQiotu^ 
Oftler liMrtpofledieRnlcsMiiia i4hich&UuIiy<UMgnu«i*wwongin>lly 
■wle und cvcfy dUdnii CMI rxill like Imunccs. Union luinl by 
adhcrinn pKh tnmoti are SDore or Im mov^lc in rvupimt^n. The 
Hvrr tbottM in a11 num hr rarrrully rxKinEiwl fnr tht* prrvnrr nf mrtaft- 

SUwuacb CcntaitC,-"To oliUfn ihv ttamnch cimimlt onr- ihoti]<] 
ihoro n^ y vuib ovt tlif slonmrli m the tTtnJDg. ^vbs a ic»l brcakf»i 
in Ui« fMiniin^ Hid rikcnild iim a Bou tcct vicil (Mt pn|{e ijS). The 
licriontiuiy VMking may ihow an cxccmIvc quniulty oC Auid fir f^vr 
prvdenct «f Inpericvt difcolko. bapalrrd molilify and pyloric oUlnw- 
tioa (tfuff).* On Ihp Otlwr hand pylorfc inronihsmc^ or duodenil , 
tfokcnb may he intScftled by Uw peniAracc c4 brgc quantitn of I 
bHr^ ' 

Cbciakal Findt^e*.— Il^iiradikdc tdd I» tcldorjt tprcvcnt vuJ xhcn I 
ftot » «sy conddeiablo quantity. Il U firolmM? thai nutn aI ihc cosra | 
to vhkit tm hyrlrochlorft ui^ ^ Toufid liaw i)Kfr vti^ \n m M i 
vkcr b««r or low.t IIm fcnonlfl an either fnrirdy ah$eat or /T'tAy 
mfaicrd. ioctir acM k iiiuslly pmnii and motiUry uid abtoipljco 
oje ffreaily dimtnisbed.t 

McTOKOfiic Fiodingf,— The mtcructope may tva^aI frafcmenu of 
jcrovllu owl cvideotcb ^li bcjaiorilu^ic the Bi.u*-0(iplrr batillm. oaJ. 
abacn<« Of ipomnsv oi ycMt fan^ or sudn« 

PUftfrnital DiSfBoals.— ^Tir fi^TlowIng fMt« vhouM br Iwmr in 
pdiim]. vijL. ihotmci^ntiVfiiWiTft"'. i**c hyfimrfiloric ndd ciar W rfiniin 
Idbed or a|iM«i nnd the tttntents m'm ov tru inftcti\T. but iti (his du- 
mocliidlk Mdisnotfnantt pain u^>tni*!r)itghi.ha»vfrhatttitJiii nut 

*S4b>UBc«» 4f« >omrttinD jieUiOed iv nunv lUj^ v voa the <m%t vith 1 
« NC^"^! ^ ^^VV^ bmufhl in t^ ■ bolintl Ufi'lcr The rmprcbiriq r^iut it 
•M* & cyil, Iha mJ 4^ 1M kkhik juio kninx fo(n|il«MlT diAnKid thr I 
apprarmOCT of the utMUftnlcil Iwjd. 

T ftr W<Hirr, l4iK«<, p it»i, ipo;, rrpArit fi«lrHm}hAcidily nr anaddily 
la iwD-rhlrrfiof bU frmOM n| fanort ASnlin^ ofW '^n^int | 

t EfEiDtfUian od Ihe albmrin ODdMainnJ In thr nomviJ ulinr ^rdKifuo tned | 
foa mi I hit the pfvriouilir cvfuJoi and wAatird uumkicti inrolvr^ loo [Quch | 
kttttjiint wt It i* pRMKl 9a)y In aSctwuling nniiiauulA ur lji lUH^Ld^'f \i^ 





MCI>tCAL TXUktOfim^ 




ocnr cxcqit ia cocincxtbn with rinbosib of iJic liter, tmniidiinm li 

■eldomM early, yaagffrtye or extreme and. « himorUn»( to bt tummL 

In MAylic id^trka «1l finillngi trt M'^tivt^. kydrctJihrK otU. Udk 

^eid ond ihc /(TMcwJi art absenii ihcrc a luualljr do pun or banafriufC 

■nd oercr liunor- EmarioHm^ is uotcUy tMt marM of fngratior^ 

ibttqji ogcmohbI exceptions occur- In gtutrk aka^ kyi^pJjirU ttid 

I is luwif^ MdnMtt/ (rr in txttst. Uttk oad is 4itMai, JwrwfAli art ivrmd, 

I emad^Htm u ^inarily digkS and a, tumor it oAtmf nxf: in the rwr 

I buuricc trhrn <«« may Jcel the iniboitd but ol ui nicer, a thidcMd 

pjbms or & mia of Klhcsknfl Khich tnty havr Rsultieri. Cfictf to 

ordy pain amd ktmarrhagt in ctmrrvn vUh canimfma. Its, bcnranblf& 

it ttfually artcnaJ, iti pain won pttioxjsmal, dirtcUr rebred t^ lt« 

uklni of foixl and kuually. mulccdlyor oa m pl ctd y fdic\TiJ by cmplyiiv 

\ tb« atonaiLcfa or by liic fnjteitlwi ol bictrbon^u g4 Aoda. Casocr occuis 

I Id i1i« nTd, uUvr morr frrqumtty In the yriunf;. FimaUy. Iks di^ffuA 

' d/ Ainfrr rnnjf r«ff cttUfiy ufKm the presatff e} latUt dod tf/f«r « 3Mi 

Uil wtval. ft>ijUnft of hfpwrrhagf, the Bods-OpfUr b^eiSmt. farty ond 

Pr&ertum ifu oj Unngtk, fmtciaiiffa^ and. htnor. 

GASTRIC CIUSES.-Ughlnlrg tike tlUcUod Agoniring. crunpnc, 
epjfulric [Ala. ubLHiiilnl willi itniuiQi or violent vumiUri^. at fim cd bil 
a few mmutpfs' duralion, later pfraetiag for hcnin or dars>. icpanttd 
rE tint fay long loierval^ but progmdvdy inacvhif traill far 
of wcrka they may occur daly, ai« charactcfutic of libc* 
iDQfl inBianeM* and may eoHfUtvU Out fnt tymfidsn, Tht ratt«vJM 
b usually aa abrupt aa ihc ooact. but uuiuuaj caacs an cncouDterad in 
w^ch pain it abMntor,th« crilical tffnniAationmaybe r^iUotdbfdam 
ledioiw inipm^mient. Int^slmal and rectal am* of much Itk^ Mae 
type aba occur, Act an earfy oympioin it b raie but Inportaai aod «' 
irrmi4ydi£culi ladctrmUnclntheahumfvoJ taheifccymptomabeoiiiua 
of ila TcacmUdACC to laany olhcr «3ndilJGini, A l^oiy of lyphilia m4 
ih* incnaili^ CnqiMncy and diutEbn oF ib« atucka combined wiih 
ifaoi dramatic auddcnncaa o4 ouct and reccaabn an valuable faclon 
in diffenntial diagnoiU. 

•Uadif of Hrrerc paroxyimal [lain of bficf duAlion | if .^ imnialio») 
(ndured by c^rrtlnn or rmniion and fnv|iirntly tiy ib^ Tmimbenl poii- 
lion* if ufvumnj: in men fiaat forty aufigtat uleriv-ackroak. Tbe 
ftOTtic rrgion is UKual^y ttndpr and anothv type Is tuavctitied wllli traa 

* SlteUu aimf* tMj be cAoouatcrcd In drvduped ipEoal pumlyifa^ avd' 

, icpanttd 



Ira prrtor^ flic iiiUdn may show the mat lendcncy 1o pn>grr«s 

OVt-T A ^VrW Cf m4ny yntt U 10 the QlM b tab«lk QriMe but *!« 

avtrr frvqurrti. VMS «U'1dni te «n4M ud ncnu'oJi anri Itrk the p^ 
Uii: diatuflianoc- Ttu &£?. die pramcr fiT Aitcriarsdcniais. ih« Uck of 
rElMlioa t<>ineib or const*ni gastric finding) diouLd lUfEcc locidwfe 
LikcT. Max Both cLiioii lh<it llic :clirf jiflurilnl %y diurtllD 5-4 jptft. 
And tincture of iirophAnthut 15 tn 14 nxin, doily is of diafpoaiic 

SYPHILIS OP TB£ STOBiACH--Ai the period of pcrH-ral bftc- 
tion dytprptfc i^mpiomi Eire Dot unmmmon thougTi ustixlfj mde- 
lemuiiAk or (Akuig tbc {omi cJ hcmorrhA^c crosuns due to spe- 
cif eiid^rtenlU- Guinruui are by rxo mcana a* uncommon aa 
fonwil} ^uiipMcd and clumsily \\i< ayi^ltilitic man Tna> mciul>Ic 
rinapk ckrvnk putric caiarrh. cttuia, rroaionai deer or c4rdaoinfl. 
Tbm pvticitlaHy ininnlirig cb9A have come under the BUlhor't 
obMrrvCkm- lo one. an oU gatllcnuD of 7i\ therr w^d a ^^pahk 
pjhhe JvHHif, fttooili nich maxkcd dilatation, cxtrrmc: gnstrlc 
tntotcfiAce. lendcmca and cinacbiloa. Tbc tMot waa ku^gcaitd 
bf Httichfn»onis& iMth in a daughter Anoth«r vtaa a >l««pl(r 
dirabrr furmrHy 4 ttOur art 35. wl» (jresenled a Halt Iml drfijiile luiU 
caqobildy loader plaque in the left fpi^Lrium and extreme portncyBmAl 
pain- Tht 3rd waa a yrtrng man of 97 who pmmted ih? tlinieal 
aymptoBU of mabf^nl p^lt^ric Kouiiu, In aII ihrrc tfK<\Ac raedl- 
cailon fffonptlr f^Uiyd ike poin and miiiited in cARiplci« dJMippear- 
AACB of all Ayui^^oms. ExLtaaiic paiii and tendcnicia whh M|n]k<]f 
caniDOBft «tn the pvomiiKnt letttonA and in nil the evidcDce of paat 
■TpliBi was dlRdlj or indiicctlj adequate. Cc^fcc ground voimtua 
«aa pRK&t ia the first an^ third. The fint and icojnd cuc« «ven 
renMiritahle bcmtv dF thr polpnblp tumnrt. 

TUBERCOLOGES OP THE STOBIACQ a so rare u a primaiy 
ruru)«Lty. Seenndary li^ona 4m coBnnoo 
TTie id^u uf ulcrr. the pRKOCC of Ibo 
tubercle bacillai uid the pre-eiistirig dijtaae in $e^ndary aiffcs make 
the diif^yBis- 

cVktg modrtUa tuu beta TPporied (uftcwntly often by Miablc 
uhfcrrcis lo cotitk ll to a ik&nlte place ia dinlcaJ mcdidiic. Ila 
•yvploaaa uv nMniiiuK, conMipaiioo. dilatation, incteucd peK«lakai 

* to a nv fAfSfmd by the ELUtbor die piln Kcurml both u va bfJObVe^ 

Not «&««» 







tzirS, in mcM iosiaD^cf. fMlpahto tumor rgpnagnting tb* UikkcoH 
pybnuL In aoatc instances a Iuduv hw noi bcvc fell aAit m ■ mrftl 
cue (McCiw and CunpbcU) the obsTnictioD «m Ap|:iaJVOlly due ttt 
ndutidvuy of the raticout mmbrsop nf:h ohctninini: folcli (Srr 
»1» p. »i8.) 


IMSS OF XITVESXIOATIOR. - CArcfoI icu|iury ^ouM be sude 
M l[} aafnAJfffi diyrt^ti. aitrz\a,}if liytcntcrj^ typhoid fern mxI S|ip(^ 
dicilii and ihc IjeUct nflcn n«c««iuic« « cvtftil cm** 
nwrrtng ihr nrtiml ^ympiArrH ptirtMii in rtiiRfimiHt ittarkt, 
dianacs of tlic MomMl^iv iht kabiia of the paiicni u rrjpjds SDkokii^ 
ririckuig. mral houn, xhir time nmsumfd at meaSs. duaneStr of Ifte iid. 
Mid cJie ctmdiiiifn ej th€ kdk uc unpcuiuil. 

THE FECE&— Tlw chumctcr of th« rtooli denMnds iunto. 
Their a>Ti»l«t<DCC. sIkc number, fonn, f^uAiniry. color ind Ibe aiMi- 
lurt of tnuciu or btcod orr Ihr thkl fuiujca. Ili* pMooKC of 
OMutlpafton. dianfafpA or pun pjid llie ivUlisq of 1b( Iwo l&ttcr l» 
meab or a EoitiDS pcHod f^ould be ihonrai^ gone ifilOL ti auUif 
inqntiy ooncentm)! con»ripalloio it ic bftt lo tik wbeUiff ihe bo««li 
niOYe (Wy B^tfA^w/ mri/*ct>r<, Li ihr ciM cJ dUitbua v€k Jtould 
know vhtfthor (1 is noctumil or drunal and induecd or in 
mrnul rxdlcnLtrit or trmociiin In orrTain fmmi Ihr lorap siod 
RtHEfliiirT a^It follow) a akt«l- FiixftLlr it should acvvr be fcvKotun thil ifae 
tloauurh nuy be ai Hit bottom «l the '"**■**"■* dlttuibanec. (Latt 
adiFJia sastrica and chronic patric falanb, hjrperiGblodiydria. cu.> 

Normally Ihc alibis con«£el oE i<xH\ renmanta, tjiit^K^'um, cdEl. 
lia^tcila i^d inaz cf llic digoLivc fluids. The coku Jcjicndi upoa 
ih« diet 4&d ta normally bn>wn or bfovaiah jrdtow, btiang darkci oa 
TTTrai tVirU lif^ ypllmv en mllb dlM. Cr^niin dnip as iron and bifr- 
muth produce a black aiooJ; aenn^ rhubaib> aanionin aod caJoiad a 
groMuah yellf>« lint In |>mloiigiMl contljpailoa and fe rm»in fofsa 
of tbpcmk obctnicltnn. '*Koat dfopfjluf^** balls, acybalj;. or b4nlcoed 
muscf pEToovod by i3)i«<tirhl folda may be MOOUnlnvd or* Ibc pipi 
tXzm vt iiUhjij tike 3tool» aug^vtinx bat oof pfcviiig ospak 
\iaa ia tb« lover bow«1i O* the other hood nE grftdca «l 
snniOiquid 4I00U may be met wiih In thr ^narrlKTac; «ic*i u Iht 
ao-callcd "pen foup*' iiijul of etuly Ijpbuld or the brilliani oduc Uquid 
of the Utcr itagp al^d lh« pfculiar rioc nater tTcwIi of (ru» cbokvm and 
cholera nuatna. 

^^^^^ tuaxxas or hie urrEsmvo— exavinatjow. 375 

^^H, ncin. maococopicAllj. of steal urc in the aerk^ua intniinAl 

Rkml hrtta iht \oma hamri vnaj he mJ or. If da.rlt. b tuiL usuaJly 
coogcblwl; U front the tianucli or upper bond Jl prewntx a Urry iii.i>j. 

onrrinc tlv sloob. or mlm) wit2i tbv fcixs. Uic siiEni^'-'Uiioc bcin^ ihit 
of pkteiCiiul caltrrh, ?«u if pcwAt provn a tmon of Ihc lovrr brmvl 
and Cfa^coii of lUttKir miy yJcU iufonnalion of valur, luusUnJL! 
pAinaiGft ftre cotuideitd on pi^^ 4^, 

Callfctlng the Specbnen.— The timpJcn mfthod GnrLdiln In ihc 
usr 'A cine of iW coTCTod Kcepitcfc* which nn be pineal vilJiLr and 
raM upofi die huSn of a nviirr dowi ir dir«rtly tindrr ihr pftifrnT Ijrtng . 
in btd. These cas be proau^ wilh 4 icmor»bit wire scmn which is ^i****. 
tueful in wishing Ot clooli for concivlioa*- Ai in mtrgi-ncy mnturf 
anj iccepUde may be uvd uu) for a virve on? may eiriFiIfiy onlinuj 
oMoquito nctliiajc fattened ic tn cxtemporiicd hoop^ 

Htcracoplc Kviininjition.^Thr povth^n to In- Maminfd b pr»*' 
pared by addloc a soudl aniouot of phrabloi^'G Mb aoluiba and a few 
dfcfx of 1% fbfnline toluthm. Konrudiy ih« appearance viru with 
thr dirt In oidlnuy mixed dfrl there juc r&rloiis >T]£clab]c iclh uiu- rMhobint. 
ally chaiacteritUr, ilarch f^ranulcs ue L>r<l^*rily *t>tsni i^r if pxtvcni Are 1 

n«dily dnnoroiraird by a droj^ of Lvj^r» §iituiii>o I'brir prrMncr \t 
pathdopc Moat Abrcs ia ttatM cnimbfrs may be Tcco^zetl as may Fjodiuiti. 
cUilk And oMWirclhv li«ue filuvs. Onlate of Ume and falty Atid, 
caldum Gtfbooalc aad akium tad amroontO'magneAum phoaphaU 
fnay be peeMtf fa duraftemtic crystala The Chorcoi.Leyden tryt- 
Cab (xtar in |iulriMinafy lulKti.-ul»»iFi, ly|.iuiid frvcr. ilyvniery. AnLl, 

with bl4arinal panailn. Kiby rvd ototaa^ sxUov rhc-mbic plaie* 
cf hematohlin, or 1i> aaaurphuus fonru, m^y ht^ imamt in rK-mnrrliavf 
or severe CBUrrtii: bl ouy alw be pirtrnt ks di&railrriMic lujhlj 
refracting globohs and both fit and fitty i^td cryitila are bicrtaMd 
Ifl dijeaaej. of libc Ihvr or puureu, and. in acute enCeriib^ 

h\0od cdb ntay be pnaeni if firxn the htvtt bowel and pua tDTf^utles 
if linn be an uknaliYC iifutrte vt ilLKluLrfoitx abMc». Tumoi U^^ \ 
cnenti» aiudn thrrxis and tk« lar^ witty od bacteria, mcifi important 
ol vkkfa laihuhipmlly i% the liojclerliun coH oommune nrd ihe tulxtcle 

ScIubUI'b Method,- A tefmal and eMmdiKl exunmuiion ot ^Va ^ 
Itktt- k onilouily too oactiai! and doK ooubvimbv^ lut v\ii; n^ntn^x 


lUDlCAL l>U0lf08IS. 

1^1 mpJ', 


pnditiootr ^ul one ^f tlic ftimploit mcUtwb b htn giv^ lor the Mkv 
erf compkuowB. 

T^et Diet— Schsitdt >uKKtBta the luUowinit did (u ccAUuinf coO' 
txanX and «ulGdfni odoriM. ^ni|:d», uid aIwits nhuinahle). wklrh bai 
l>ceti iliihtly tuodificfi by ciaav dificwot obwi^rra. but npixacnti ibc 
baAifl of all '*roTmii" or l«t diets: 1.5 litiw milk. 100 pn. zvribaci. 
> fg^p 50 |;in liuicrr, 135 giiL very nuv oi niiv beef. 199 gm. potatoa. 
a&d gnid Irvin Ao pn^ o( (mUdcaU aAd, to ^. lUg^^ or, ai ued by 
Sierle?— BrA?i^/f3«i: 3 4rv^> } of ilw anxiimi od ornA »<! buti«r, 9 
^ojoci cif milk, oatmeal with mrik nml ?ujtnr. DmHtf. tht BkAk kml 
potLtocsp ) of lb? imouni of toati and burt«T. i) j^maw. malk- Smpfrt. 
t [Innni of mQk. rtcnatnilcr of lout fiiid butler, i or > cfp if dttiitd. 

'thiM tit«<d b« git'OTi iot only two or three dayt. & ciprale (q.j) car 
mint; bring ;aten with the dm nu^l The ajipcuvKC of the ^yt 
tn the 5tool mrtialcs llie ciuclnaLion and Mma to nKUun llie tinM 
of patifigr. Schmidt than fwocnrfU to dfLermine cma iamm, cokf 
ind odor and rcducr^ the focci to a liquid torn in a mortar «ith 
distilled tvoltr. llie Ardboiy bUched fJaM or a Petri did} plated 
oi^cr a btadt batk^ui^uiid ihcii fadlilalcs the naminailoo. Nutmall; 
Lh«rc abduld be nothing eaotpl the indigeettbb oMjiimI bulla 
ugD'like pivniclpi of pouiiL P.iLhobgicaUr om Eimfa: — (a). M' 
appcarinf as sbusT flakca wtnctimt^ »UuAcd ycllcw, <b>^ R«n»anb 
of poTali) the TT^tmblanM oJ vbirh to nturiu may nqnin ih» mkT»- 
KQpc lo diffnentialc. (c>, Rcinnsnt^ <)f muscle ibrc indjcauof 
impaiiTd tntOBtinnl frrmenta, tfiioDO of tbt vut^rme (entc»»kbi«4«) 
or ahminnd Trtutililr' (d). Ciyslab o£ moKncaiurit and acuuuaiuB 
phcisphatB Lndicalin}( fd^aibuicc. [c]. Connective tasu* rcniaml* 
diffrrenclaird fmm mums by iJidr toushacn. (0< T^tui or blood- 
(i). Paraail» (b>. Concretion*, CiV Fotriffi bodies. 

'Pir macroscopic cMminaifon morrly conAma and ii>me«hai arnpS- 
&C0 thcac firdingx I( ib ircammcndcd that three raounta bo □kade- 
U]* A drop of lh« prepaI1l^d material. i9\ Same -|- actfic acid. (3), 
Same 4Jt Nn. 1 + adTTiq>of dilute Lutpt'aad. (iodine 1., pul». iodide a. 
■oter 50). No. a b heated 10 boJlinjt before covering and upon cooUnjt 
vflJahflir faliy aft1 rryiials wt firr by ihe arrtimdd;!! rrbeatcdthfte 
■ill fonn dropIrtA. No. \ sbowv tljc rioict blue reaction ol potatoctUa 
aad cvrlain Eporu. 

Tht dicmicil ciuninattnn ccoaaato r4 3 luutine ic5*a:— <i). The 
reaction obUincd by droppini; the prepared TnaUrioI lalo a few c^ of 
dibjte aqueniia litmuA eoK [>>. Tbi? uihlimatc irvi. (F^iul partacd 



Ac pnrfkftred mnUrial A*d ft toL M inercanc chloride [ii%] ahould | 
miikt a jjmfciH^i rril rofor tndjcAliTi^ hyiir>t1iilifv1jin.) UndtttngL-<J bile ' 
pi^Dkcal ric1<b a grrm coWr acid U pallKilt>^c. (.i). The fcrmcntilion 
f«L— J c.c. of Connnl f«cn, or lU rquiv&lent if Jkitii^l, nrf pr^ponrl with 
iierilc waIct and fwni^ mt» the bottle of StrauborgcHs Aitrumcol I 
or bettef ibe uapJe ind «auJy dc»Ac4 modificattion of Slodc vrhicfa i 
can be made b> any nnc * I 

Tbc iub« mrmotmiiag iht boiik U lulled vtith «>aifr, ih« tmiulkl 
tvbr rnnwuing ffoptir; if kcp4 a; hlxKl hrut fcir J4 honn gu vJU drw ' 
Ofid diiplsce tht waler in the first (ubc forcinj; ic into ihc «akr p^ralld ; 
tube wboie air fiiwl« in ouiirt through ihp lofigrr inner lube;Uuvilbf 
ajnowit «f Niter dupliice*! U a mcojurc of the [unaunt nf fCM futncd' 
t ttiiplaccfluni ii dUimctly pathological- AlLuminous pjLnb^bn 
ia HcKcaied by a Um\ ismrl anil alkatini^ rrHttfon, cart-cilijrilraie 
fcrmcntiiion by acidilj. 

IjOtoVDCaa from the Tfets,-^Wor. A pink ci^lnr rrziction (IM 
a) bnomial. th« srcen todicvics incrcnxtl motiL't^^ AEucncc of color 
A fal ttool orabcence of bilr. ifrjf rmH^ffir, Whcltid muHcJo or 
cxKiiintiirc tbsuc ijij ncii il mlifEjaoji^JL. an rjL(i;A vl rithcr U 
paUMlogic. lb the cut of (oDn«dir« tluvv. 4HJciotnc ^utric dige«lion 
il indualtMl i>r evcrttdvf ^itric mulilily. In ihi' rau« rif tt«! niaclr 
the liiftaiivc tntdbk ii probably tnkatinaL Ac cxccv of fal merely 
(ndicau dcfideu dfgrstkin of ihit mnr^nnt bur flugge«u fcepailc pan- 
crcalk or bitesilDal (fiaouc; femtenuid^fn nicanK either pour Aianrh 
di^don oe inieOinal dLifturtiance; Albxjmin fermeniAtioni ftHtivr dvfi- 
cnmt i^tiic iir iitlcatiLiol -tLiiEDlioii or iuuvMad molilitir. .Ha a miitur | 
of fiicl IE may be staled viib rtgrrt thai up to the prwnt time tb« cunounl | 
of Infnnnathxi giuicd U too tli^t to tnaij«a»le the busy pRtciltmrr 
lor ercn the taaH acocHiM of timt acctattrily conaunied. NoihioK 
but eooaiani practicie tiill suffice to e«tab1ifih pfoprr «iand«rdn repfvaeni- 
in^ Ihc nonnal and the abnurnuL Arid finally, prvikid fimaeQtaiion 
ii m^n «ady anamaiad by ivsiing for ind^ixyl, 

CoEicrrtLoa8-^£almitibLf . HiitcnvUtliA originate usually In ilw small 

• Tilt EuuriaU nj*drd al&— « large tnoaihtti mrdluni nitrA H^lr mm-- 
fng ■ rabbrf ^wrt. prrfiHsitH by a kIu* (i^br. Twii tr*[-TT*]^i ntr prrp&rrd 
each bETtav a rubbd cofk ulih t«o ^itoru^n^ Uoih arr interiril jtnri 
cocuvctvd Bf A U lubr Itv i^ujf milli^ fJ HMirTt pnjjni ^i|:liiJv almr the 
iiiivr swiace «d thf oodc, one i> then pmstd 6ovn fw-i the Tcn^ca^ jirv 
jtctiDg tube «f the bottle end hold* fbc oTher e\lIk rivaUcI wilh il b^ vutne 
^ the caoBMlinii V |«bt> Trtr-tob* N<i. a ■■ tiu«4 wii ti a «mAl] gfiiB tube 
tfUebfaa tuaily lo ihi top L^rul projcru belov. 

k — - - 









iftlcBCiscSi are iHuiLi, Ugbt m osictt uid ofdinirdy ol no importAncc* 
rooaisiiog rhMly iif nit^t»lt tnA lime Caprotiikt, ThtM nuki^ 
>h«ped bodks nrr moot firqucnt in tbr apfKft^tb. (tcnun, mccuktioos 
anf4 rHtuzn. imrriy tlic; ailain xixiAldmbJp nM ar«J ouj ciiim obiinir- 
' liim. I^imcrtAtk cj^nrfj. These may be facded or arc. lanially. loui^i 
Mul friflhlc Uiry contain na bile pigment ftn<i clii4ecf4ffia »Bd aev tot' 
ublc in lUkmirnrin. AiiUarr fHi^iiti, Thac occur oa wdl Li 
(otticd boftiM. or, il In llic ri>nn of sukI n)ay mqu^n; tibemicaJ 

for tlirir irl-'rilTfHalion.* 

HEHORHHOlDe (pi1«).— lliU common mndllioa^nrc ia <ALlikt»» 

moEi frrfiuernt in Bim. ftintktft d % ilifTuae cir tiimiriMTibrcl miciodl| 

of tl^c hciuorrhojda] iviha. dthcr in the lower ponka of itw rectsB 

(iubniucDUs) nr a( the xnt^ margla (cubcviacfiDUA). liw rontUion 

is bOiiLi:<lb3-ui(iati|.«t>un. (unlinuouAMandin^vf a^liiif (i^ aedenuij 

rxrcupatkma). llic hflbituoJ UM of caihartks. pre^ci^ncr, ihe ittcaufv 

rff Itim^jnc ivr oUilmtii'd pm«| cimilillon Frcim wbatnrr aii>c tnd b 

. bvarcd by the lock of v«ivc9 tn ibc hdnovThoitUJ wuu. TJWy opt 

L ffvgatfolfy o wvrrtf 0/ iMMfrAd^r u<Jti/A /n nr/vt May t« ilr n^J CMtff 

u/ dn dJbfnn iBfitfmhJ^ o/frn W « Mkul invrr ly^, FurtbomoR iW 

f r«<iiienc7 of Ihc iMion may 1««<J to thv loo t^ady aitcrfrinnni of a ptticilfft 

HijL^iHU Liid a E^Lir? Lu tirujgnia tlir cmlieiitr»t miaj tbaurr, toirfgp 

body. maL'Ki>anl ^:rQiTUi, tubcrcvkuA or iTphilitic ukcfufoa or fittuU. 

{a fcdHl naminiThn \% loo oflm itcjilcnBl ihough lu iHii^mtfiki 

I fcftliun are \a pvl rcmovcii hy ibc lue of Ihc rubber kIovc ^ inp* 

Ittbi^Id JUimrirrhokli nrt- ri^^y rrrogniutil d iuptv6ciftL Ifae paticM 

bung uLctI bo tAraln juid bcu down. i*bni the irtlJlsih blur ftodite 

oill btcpme evi<kcL Skin In^ nnd condjIoinaUi aic oonvnoa bni 

ouOy differeniuted. lolcniaJ liffnunhouk may mqufrc die un of 

Ihfr speculuinp lhoU|^ vauuUy rrcOKniwd by dijCLtnl euminaiion. Re- 

lAiard frcal maltrr h»t a rbRfanerlGtlc Icel atkd mBh^piUkl gii»vtha 

an |ici.-ulMriy mduraled and Gnn. In any ml^ nasnoatiDB ite 

tonua. i.<. ncifUncip offcmi by, uid gmip oi tfae uul qtbnckr itolld 

* TViT- Powdrr the ildne or gra»«4, wM *» cc- of Mbcr, mfa Ihocot^Mr* 
filtfr, ami r»»pfirn^ filrr»Tr, *»*1p midur n t portlwu. N* 1 i» dtt 
uTiliTcl in hot dcLitiaL Allnwcd u- npnorj:^ wiinnol hnt anil IIh ratidva 
I rtAmbud foi the Jb-jmljoid (ijiuUoc cholmcdn, NOl 1 li UMdrd *iih 
HO and « tJ4» of ffirk chlurlde; n Uuc lolur u[i crt^KvoikA isdlcata 
UAlcMtiUL No t V pUtrd on n UUlr, Lmtr^ wiib a drop t4 cooccninttid 
■alpbark acid andcov^rrd Tht fhf>li:«icra<:ry>tuihuwi:anDac nufgix^ 
Anodiir pcotkm may tv trq^rd vlib diluct IK'I. hntod, (oi4cd Mid 
tnat«d «Ttb chlflnform; 111 Uw chlnnTfarm enraci GmtlJa^ Ml C«r I4k 
pignvnc b apfdlnl 

Daumi or tut u iuiuij.s-'i:)fn:uTu. 


be BoenL Ii fa nttrlcclly HMtd In titrtabi orginic nervoiudlMMn 
ajnd in obsimctloo of iLv nMtum ukd ti^okl flcsiuiv, 

UTKRITTS.— In the iliorrbrBal dimsn one must tlkttrguuh Ifaooe 
aJtectfaqc 1^ anuH iiilcstinc dlooc from ihoac invcJv'mg Ihc ct^Ijn tA^lu- 
«AT«I^ or im parL 'Jltc [aim. move tcvttc 2nd Itkdy to be allcnded by 

neftHy ftU EotRiA of fnisifki arv iriTial and irmpcmry Sn tho cw ol 
iW ttdull bm vuy BBWv coo^nilcnblr rmjxvrlance In dir atn of fnfantt 
Ajid TTonns dktLkcn, oocuiring tuiulty untlcr con<lit»iu of tnpiDper 
ttottatka 4V ofU nore beqaeatly in arti^cially nr liodly fed imfttitt- 
fiuvrd JbCuriMQCa la ImhwI fed inUnu «rc urc And uAiAlly tcsnpuniy 
uid tnvial «aUM Ma>*du7 to K«nc gr>ve primary ooaditfon. All 
wictia vc pnncr U> apifcv diuiriK IhjI Kfstlici, puit»u)Af1> when 
nlRUW vuntinoa in Umpvntuir and bunidily vr prcM-TU. imd rtocli 
IbHrmnxii&nvi b inmnloKe s^d inorlality it July ani Au^uit. Mitk 
and vater aie probably tlic cUcf rcludr^ oi oopinf^^^n hv\ the dcmoO' 
■iratinn of a jqi«(f6c hacOlui for Ibe <vdia«iy dttntitfal dJsMHi mufit 
wtnk funlici ui<talif;uiua inaimudi hs a fatfgc variety of orica;iLBiiia arc 
CouniiMonycdwhkh ani|uit« cvmpvlvnt in 1b«auilvMlo prvduof df- 
Mti aympUnu or la net oiih And Itilc'iuify ttt iinilnicL' of nthrn.* 

CXnicAl VariftiM.— Wc nco^ixe (t). A<v1« ln1««tiiial Indi- 
pettoo- (>} Acme F«rm«iUt]v« Diarrfarva. t^)- Cholera 

Morbid Aniktom^. — The palhcdoKlr chan|Ec« In fiti«fiil< \'aTy from 
a mxve amgcaltm oi utlairbal tunajiunaliuii of the uiuucu miTh alJi^l 
biltimlion oC the mbmbcvon and vnlargemvni of th« lympb fbllidfe. 
loMtiHl ulceoukfi. Uktnuod aiv» are firduurOy limilrd. origiiuu- 
■hc iti tlu foI£clc bvi catcfidjn^ by ibe coaktfcmce of <yintif;uoiu u]cen. 
Ln cambbicd kdoofl of ihe npirier and lover howT-l one may <d counv 
have all tbc dianjcta dcacribcd under d*iic(tlc:r7. In ihc niiorc «cvcrc 
type*, paiticulatly tb« combtnrd forra. fc^mrtkh'V pneumonia is common 
Mid ibe tocm p(i»m cridcctc of acrcrr luaxmia, 

Acoto llH«Mli»J IjftdiffMtica.— Colicky pain, fympanitfa, and 
diarrlKTsi may cnnv an 5\i<it]cnly. immudiaUly or fmm Brreraj 
how* to m day aftei aotac didcijc indiscfttion or. nitbout apparent 
»;t 1^ Irver la vunlly modeme and of brief dir^iiion. the pulu- 


,Ulwb tnitfsi BliaHwi lo 1 h»dlhB tn^Ti-'" ---rrti ivy DuvjI and 
vbicb fhiirl^ mrm^jlnSbita** ^uf I- .i-ry Afkd ban bntr 

In a lartE nualin ofosuof ihr tfuouTjL. _:j_._<_-u«f ddldsriL 





' rate b bcrravccl utd in Lhc tfaild may b? eitrtsxtj latiid. The 
arc ft! Sni teal, Own wtlcry and cort\Mixt miicttf Mkd food 
imjirHfcily 'iip^ird; wdi id ttiAck b ontbuily cui Kbori bf Ur 
«dmiiiiatntion (>f Aome appropriate Okthuilc, «uch *» oAor oiL 
Acute F^nii«ntflflv< DUftliorav— Thi> is irhm<trriic4 bf 

, marked jympk^iu throu^oul uid m*}' ccme on vwMcdy or suoceed « 
mndcf atuck of 4cure intntiul indJgniiDD. Vomitinf u osmJI* 

; piiacaL the ftvci nuy raich 105* F,. the piilK a npjd. ocmMtt ^r^^- 

' lociM utt pnnouAc^d. uhuiftfoo mftrkod oad, [ft c^ildr«B.< 
KM one unconnwa »i thi ensM, Tlte- Aionb an more (re(|ueac 
the Staple form, npKUvbtcomc wfttcfy. an i^itCT in coior aftd rnnlMi 
Dn>cb muou. Tie discAjr u ordiiurily of brief dunikin mnd hvook 
iiblc tuminiiioji. but jn*y prjix the amuneaccaicnt of ftD ilco coHb 
lad may TcnriEnRic lattlly by comA, cxbauitlon or 

Chronic EntetitU.— ItnrdlT Jualfio « Kpan:cc dcacrtpikn. 
charartoriccd by IntCTmJtUnt or pcnlltetkt lymptooM ol a mild •oft 
which mirror thr ooiCr sitadcft If long <ontinu«d It fmpain tfnng^ 
and nutrition a^iil it may be anodAttd willi mild d^y dUntoft, men 
Ultfonncd vIooUh ot. obsTin^iie or ^itmnlinff coiuiipition^ 

CHOLERA IIIFAMUH--'nji» lulLnciM, fruisihably laUl ud 
piwtlflDi In Ifao lar^ dliec ajxtoogH tiM poor, maf afloct tb« chilfkvm 
ol rniy age and b boLli iiinrulic and endmit. The onari h umaDir 
>udden^ iritb higb tempcniurt-* Vomiting is ufuaUy pTcaanl, and ihc 
stncAt tt (int M6 may mcb to or more dnilj and mpjdij bcceme 
titlnrj, Ujcbt >d1ciw or fcrcenidi, then coIotUm and odoHc». Tbcn b 
markod thirvt. llic urin« it t^cant isd nlim) aJbuminoiu and tbt dbmt 
usually IcnniQuIn futaUj. ofteu witti drlihuniH atujKir tir oima and pft' 
}iApA conitJsioiu. Marked l}'mpaniLM b not prrvvnt nor ia the abdo 
men lender hm iherr b cridctin; uf prafnund tolla|iif. the feaRim 
being pinched, the ikin uhy ^ay and Ibe sorface usuaUy cold era 
Ifaoirgh retia} irinprraltirc miLir be hJfEb, tUa^taHkt fat pndomlnitinili^ 
a df8cnt<rry and will be d<«t.Tibcd unda thai heading; the mall inies' 
tioos srom 10 be primarily irvolitd, but lympicvn* Ttry floon bccocM 
db£irKl]> i|}y:nii:fi<:- 

DYSKATERY.-D^finitiOD-— A tenn applied to a group of dig- 
eaan chamitrrijvrl by acuir or thinntc biflammaiina and ukmitrm (if 
the lower bovFcl. diarrhical slooU, containIn|{ bTcy>d and mucue, and, 
•noctaled wiih o>1lcky pain and tcnomuc^ 

*lliii muM U uLcn by recluoi or raglna tmuK c4 lov Mrfioc tna- 

fir lA 

(Mt€t Sinn.) 

Bti4)U)g7.^Tb« dnEm may b« primvy or wconduj, uuEe or 
chmnlc. Tbc vccottclatj cun dcpon^ upon a primo/y cmuv, midi u 
mtocQlovil^ aypfailb or BftxhC* dbcuc The primai^ cu*a r«II UTKkr 
IKtw hM<S:--<0. Awfhk dyinUry [9), /(faii* i/uvijf/ dysmtfry 
{U^pkad dy»mttry\ (^V J<»lf calarrAaf i^yjrniBcrv fiiculr iUe~coHiii). 

Auttblc DjMiittTy.— TV nmorbft d^wnirriir wu fiRl <lBfrLb«d 
I17 Loinbl «T)d I^ooch in 1.S59 aad finrt identified in hr|j*ii(: jihjicnA by 
KATTiUkp but I0 Oikr'» dcKTipiion (1890) »nd 
iHTcfiil vorl wc ovc mofii of our kno^lc^f^ uf Ita 
imponwm a* ui dkrli^c fwtor- It b rrom i|; Lo 
M ^ lit illiifnnrr. i.p fibAiil Twi<v ihe <1biniPl«r of 
Ibfl rc4 btood cdl. o^nUina a nucleus oad one or 
l«o M<iJol» vurF>und«d by ui innrr gnnidftr Aonc 
OIL*] ji dcax osier aint. ll ouitrs from J-} of aII 
CMC* df liopicBl dywntery and il a wfirm »!idc t» 
QMd Cor cxanihaiion thr ftmnVur nuiy hr rrndily 
kkfitjfied by their virunurv and xnovnscnt cLod an 
DMBllj oottUined in the flak«i of mufu* or pi^H of the fe<ul diEcharrtri 
or tmay be oblAincd frotc nbacgaq or lUined in utu In Il>«uc» 

Ac«t« SpKl£c Dysentery (acuU iropicaJ dyiciiicTy).--PnclEcaUy 
«IL liupitAl i.l>?ciKrLic» iHil cJue tu llic funaba arc CAUKd by Shif^'b 
badfui vkkh produces ifw dlaviM in aAtmats by inoculation and is 
■glmffULiisl W ibe bWd #rini of affrctrd paUntU. 

Acute Cdtarrbal Dyseoteiy (acuic ileo-ocdtti>). (foUJailar dyt* 
«ot«vy).— 1 hia ia the ordinaiy «eQ knovni bra of ^Kniery cn^oun- 
tend ia tbc icinpcraU iOM. No apcdftc KCmift httvc bcco iMlaicd but 
a laT]gv t^ncty bav« b«n dncHbod aa Mwriatwl with (ha prooMi- 

Dlpbthcritic Djventeryi— This ia <.Lanulcrtzj^d by diphthrritit 
infliiiKTiatTan nith citcnaivc infUtntion and Fonnot^on of ilougha. It 
b oft«A Mcondnty to eihaiMting chronic disrasn aoch cu chrccic rtfph- 
til>». hean dbcAtc and lEnlxria. 

Sympconatology.— 1'hlf 1g Ctfcntlall^ the tame fi^r idl varictiBa 
tlmagh wipug tpiaitly iu dcgnc Any fnrm may become cJinjmi., 
iPOfacol fanna are bolb endemic and tfddomii:. tind for their develop- 
tookt all formi uf |jrunary d>«nirry tleil Ijui wriithtr. It vfill ht 
ooled tbal the annptoma an prcdscly tho^e that mi^t be expected lo 
foltonr loflaEmuilao ol the lower bowel pUa widely Tailing dq^nva 
of H^fffff fB- Tbc ewd U tfdJm nmd iriottni lo all tropkal ii-ynni, 
being ofMo aim rial rd wiih (hill, wIierr^A Xhe mildf-r variety b oHen j 
bjr am isilial donlKKL Abdc<uiLDal diaiica aud fevci «x^ 





lO^Dtcu. DucNona. 


I likdy V» \k high durtng Um? acltrciUfccW >lt loffKuafidl«br^|4NM«i 
,ciui Kt m«rL«). EsteMd symfi9mi. /'iirxvv. mmvJM fmii— g 
' fnwv c«fkt]r ^tfMu. MMfUiii icvvv l« ^ A* iM cuwAt« lAtPtf, pitf 
' /fcidMfvfl, «i«^ ImrfcnMSf ^i rarjAi ^ dflfTM vnr tkt dncmdjmg Aolpff 
I OM jyat/lMU tfpiww j ii i# ^ ^^riMf, TBtf alMb. Tbnc coUttb b«- 
riK. hlcKxf >n<i VTbJiJji. nml In thr trvrret f<iniw pw tnd ifau|^ 
i^nuk«u>n 'Hic number <^ vToob vaiic* jTMlly. but majr rcadi loo or aio«c di 
htu/iiU, ^^ ^ boon. They l«n4 Ui b«<oiD« Uli^ •ml Mcioiv in Mwre iftd 
I tuinticTcd CAM!*- Tbe cihauaitoa b gmU )« c roouLfns utJ ^unk 
I irhlAtian Ofv often ilucni. EmucUiion ii of coDfK mpAd a»d ■■ 
jSCirencMc*CKUcnic. QoxLilLtu is muuUjr pncedctl by « ibort pokd 
[of onBnAf^ dUjT4i(BAl iiogli «nJ il miut be rcmcoibcmJ tkalin cUL- 
I drrn miinit anil hlood mny Jipprir in >ny »wn itiatrh'RiL 
I Chrdoic DyaralCTT. Chrooic irdii^iacx. rroAnvnl djrvnaok 
slccLcii of viryiiig dcgreci ol trvrnij lad marked cnud*Uoe m llkE 
chici fcAluna in chronic ouca. ^ismy of ihcac Lkvc Ikyd found M 
be du« to Ihc pcndticnee of m ntAlaria in Midien muntlnvt Fiom tit 
trD|ii<:8» W: «ny lorin nuiy beounc riimnk ttnil iturlnilAtalirr ol tkv 
toTO mtoPtiottl ind m»y ImI far a few wcclis or moolh» <w cvco lor 

DUfcrontial DiAcnoina.-'TV pcciiUu chander of tin tlkirtKn 
vfiih it» bbodf itool* ittd MurM kivfoiiu avrvw co iSMiaguiifc ibt 
■cuie (ufm; Amodur flhouM be Mvchrd for In nq^kioutt uofdcil 
iljr»rntfrrandlbr>prcific>K^utina(ionn«dknMiBghl. TT^AMi/ewb 
mdily {lifrrrmttx!«<^ by i& jTiariHaf «ii.m» dSna-ftatrUm. rott sfM. 
ttmpcfaltMtt curtv arut fin^itiy 41U c^mboivdy hy iJtt ascluiimtiimi 
. ttst wilh ibc l}-ph^]d Kcra Aft it ordauuOy wboUy Urkt the rfaonic- 
icriilic dytmirrii phm^^ic&t ii^fuAuin Lin sdJom tniat. TiaAcrorfvn 
or moJigiutftl vken ihI /vft;(i« bdii^ in th« rectum niiy caitf« mi&dis 
mnn or IrA Hcttf'Jy ^tnulating chronic d^vrntrty. but ih^ n^BocitMl 
Icson utd thr nrvilli of loal ard microacopc cMmination hiU ordl* 
l\llrily dfaeingiiith Ihrrn 

HoiftAtitv lund General Comneftt. -Ilic ilcatli nu b of gdww 
lij^hffl in (h« «£vcrc IropLc^ lomu ami disi^fuci^' ul ih« ivmfiwail* nov 
is Hrtilum laut e^rpl i» (hildtcn and M ^icoplr. ur. peounvnbsiutcd 
by diKov. U:i thv <»ih«r hund Ih« l<>uil mort^y 10 duoBic dyMBttiy 
undrr condiiriinH fif pnr fi.viL 'Tirtctiivrilirtg and flmoiJ fciMPlmlpn 
leay te ntfy havy. The Unilcd SUlCA govcrfemcnl h alifi pft>te^ m 
iu\ft namhttt q\ penmui for tlmb^Uiy utrfliirnt 10 chronic djwttloy 
of ibc GtD Htr *nd Uic ^mAv durioiE tbti foor^tv pchod reused 

mcA»3 or m omsioixft— NmiiMEi* 


ui fwnnnopa loUl, Tbe mnrUHiy hi /tpnn tr^ the ilKadr fotloMring 
the ftcA intFDductioD ol tbc djxajc reached 047.000. 

McuiluWMHim Ecicricia <mcinbntftc>iii cUarrho^ rnuccnis «tl\c).— 
DcttnltUiM.— An allniii^i* i.1(af»(U<fi«r<l b> lix: jirrKiKi; of iiiucua. 
tvttuntUv.ln the loc<4^ Utiology.— Motv lomm-i'n tr\wi>nicn thuJiln 
nta, ilih iflntwn tccnuW^r)^^ Jt)xiulral Lijvu ihc rlnaeiit oi Ljatcria 
And iMvnathcaiA, but b 4 nhtivd}' rue disfaw, moat fn^ucnt in 
cvtvnha with »a «iT«fnptiM» nr nrhytui KicixifA though met vrfth 
indcpciMkiuljr of tho90 Aflcoiou. Srmptomt,— Folhyninit an nllock . 
nf ctbstfiuie fcmitlfation. liaTent. rnlfcky pains occur fcMndAtrd nftrn- 
liiM» nitli dUrrbun* pviliaitt uf a lij^tcnltiu; tyjK^AAd more or kw. 
dlcMvcl d>*9p«ptic «ymplORi», Mun^UA fauM« ut ^iidiugvi wbkh | aiuevi;! 
m woftUjr graj>B^ vt^ulc ribbon likv ur nrassbmioua. rarrly, ruroiing 
oanidcle mofttb of the JutesUiial caoaI (tuboUr form)^ Their natujf 
may be p'ovpi by rirter's method.* 


fipttsm ES&lnurU In^art.iKlv AroondAryiti inflamiOAtciTyor ulnritfvr ptnc- 
cum dlbcr ai the nxliim iiseU. tJie Lukm. chr nats ur adglilKriing ! 
OfflUH. nnlf It is wppose<l lo be piicurv. Defcutfion u intcnaelr 
piin^ the uiu« It KtuidTCind mUiunt, rniuurMhelirbrbignqutrrd 
for Ml GwniMtban. Peristihlc lUtrNt tnochtied with burboryjcml 
mj b« primary at arcrvLdsLiy, The fnm^^ £a « pure ncurotbi, ifaa 
Uncr mftj be «a*odllvd with variLjUB i;utric diatuxbanca ur with 
•ctml obcUUCtmo. Tbe coa&jtkm ia usually Kwmpanieif t^' <on* 
sdpttioD Nod m k% iinirury .uid sererr foim i> hpftriu, neu- 
rmstbcnU cr faypocbnndria. It U u a rule ti^^ioi and unimporuuiL 
MfltMifiiiR.^CAMaB dlfMMfod k n mcc lymplnm mo hpII knfmn 
10 PcquEre cxtciMivc ikaeTiption and rcfult* cbkfly Trom the fermm- 
tatina of cubekydntn or proteidih InqucniLy u*odst*iJ with %n 
obatHKlion. lauatty lepqMirary acid purd j neurotic, hot it aho an impor 
liAt oiaiiiJoUlkiD in tnM obftnction acd fxritonitut. It may prove a 
noublBwrne and dugcnmft (londiiloEi InibelyphoLdiGUilrorany vtniknti 
mleicikin and b pArtkulottr danip^iwu ta pneumonia i^nd chrvftlc 
locnmfvnuieil dlvnv nt it' heart. Enteral^la Hak more hada la 
(act iLin i^Btialf^ bdnc dc3ti>plTv« of ordiiujy <olicLy pain of lalcfr . 
tiiul origia iih«(her it b« primary or Mooadaty. 1 

Bypogaslnc rtearalcia.^Tliia trtvrt haa been a[:'pUed to a paicJuJ 
coodflMtn localiaed in the epiRMVlrium ftiid lowYr put ol tb? b&<k uid 1 

• They itfT riraSrd urilb 4uilir»uitr ilaJwA *nJ ilim y'lfUi 4 ptm «Jnr I 
irtih eMfch'« trlacU Midn hi amlradfaUnctiijJi lo bbrin ahlda suins trd. 





OjiwdAEcd with Mvuc oi prcanira in ihit rpctura, blvidrti utoni* «4 
vaglnfi II U purdy a iiymptoic, tindoubtoUy ilepradeni upon niciiM. 
om^. hcniiihrrhaidal Aiid oihct tiraibkr oooditions. BfpemrthMiit 
pAfttSthcelj^ AQi&«ihesln,*-Thc lnt«uincc than nltb other ponlom 
ut thir boi]> iIich; a.> Jiipiotiu of byvtCTu or ncuruthcnk uid ih^ DM 
infitquenlJj lok« th« form uf tuni m 4-p(iJcpn\ They &» iBDpoiUil 
only to tlie ponnDar of them jam m aitual (tiacuM ai the bfiin ud 
cord when rcioI anic^esia majr be ci3MdaE«d wilb aphinfter pAdlrni 
or. H !>]« cuei when Itie aiucAhiaU \rmis lo > 4ntoiit wumtibtloa d 
(r^ DiMNa. Intftititiil iLemtiteiiia U jci^n » pWcc by awit 
■uihore but El U douhiful wh<nhrr ihc coniltlii^Q KtiooM ht to 
digni£tiL Tltr U'nii n'atly ap^ilka [u llic ncunallmiiL- AUXf whh 
latdominancc of ahdombaJ ^mptams. PftnilyeiB Ol th« tnlet- 
flBBi,— This has ftlnuJy Iwrn rcfcnri to on pa^c 6$, The am- 
dklon may be a very iicmui oar and prrvciilti tahny at the ^mp- 
loms of ohctncllon. It JA suoriaiAl wilb direet abdomliul injufyp 
Upwotomy* diTODic u^iuaiadoD anil ulccntirc discuc» of tfe 
intcftinal tntct> with ijrofound liyM«rb> mtUncholit. bypckchoB- 
dtb or afluii) M^uik (UiDiHe of the Lnin «nd tcirti niul U fnvii>mily 
obKlvcil Jn pivi]oTif»ed and wij/jTtf fpirni impaction 

baa been dealt v^itl) uti jMgc 4^. Chr»iiic obiitniclloik caty be doc 
to th« iun« fnitiipt unt one t.t rhirEly ei.>T^crrae<i with i£c ncoffa- 

Symptonu-— These nre extFemdy T&Habk cud often Qb«rtn«. Hm 
hktnry of ptFvfniii nnmeniK vi iTnjnrtnm u Ji ihr- hddnry of mnsijpithm 
djoirhoa or aymplocu vujuotinK pnwJbIc ukcntion of ftppcndidtk 
Llltlf 4iiru«hoiiMbr Inid upon thi* pi[v>4^iraiorrAp0lik«coaf6rsuliiB 
of ihc vtoob » ibcac nuy be met wii^ in spoatk otuutipation <jr vul 
ipojm. Ttie gnutoa) onwt of th« fymptonu » cb&mcteristic Al 
fiiat tinritly noiicenblc. they may betiitne »cierr And ttauUnrKDe lAd 
nlwiyi depend ffrcaUy upon the ftie of Uie ob«l7vctlM- iTuo^dwf 
iCmti^ prorliim fiympu.4iui ntran)c1y rrsrmbling py\nrit obstmctiioo 
ftnd b frequently m»odatcd ivilh the vomiting of b^ b quantity thw 
fndieilfng ■ Aricture b«low Ihf pApfll* of Valer. Any marked ohicnie- 
tion ill the inali iuEfjftW xnitl be accompuiicd by a gn^t tncrruc id 
bdasLyl- end the motv remote ^l is ircn the stomadk the tnorr will thf 
oolleky jwinH and conitlpalJan predocdnalc cpvrr thv ^tilrif aymptom*. 
DAiuca and vomiting If U tit Jnt«r iJcum «r coim there n^ybc Di> 
gutilc Aymptonuk hwaX (Uvun^OB of die abdomoi or vbible pert*- 

jllrf BLi- 


Ulsb oMj ^m ft duo to Ihc iii« aad gai^»g tod bubblinj; Mund* 
taaj be Sttdlbte And p&l|^blff wHfa or vtthuut ili« prcnunf i^r ihe h&nd. 
It viAjr be posaftile to rrcosmw the Ibrgc pcdatiltic wavta of Ibe colco 
W coapAn<I with ihote ol Uie las^f inttfCtcaJ coIUh but it i« cvidrat , 
tlut this M£ci miul ofltn UIL ' 

Ctarooic IntnKWMfttoo buwaliljuwcUlod vithpidptbUiumor* 
lilMdjr MooU and tctuvniii as !n the «cmc farm. Sis moM frrqurni r^n-'ir md 
vM bong Bt the il«o<«cal vaJvt, Old appndioefkl adhcaionA majr ^','^^* 
pvoducr dnooic ofadnifTion in the itme n^an bui Iac-Ic lU di«linctiTe 
qmptoins of JDtWBUKcplion, In thi« connccliofi h niajr be Hud thu 
toOovng ftppcndiddi. adbcik>fi« nuy occur about the cx<-uni ar the 
Mcwdby potlbn ol the ookn produdoK uLaLlri&tc couslip&liun aitd 
li«^twn< attftcka of morv or k«B ntnne pun Ihwi^ th* ftpfieodijt 'u 
Cound If nfrnr^n pradicallj nomiAl and irre* 

CONSTIPATIOIf.— Tlu9 conuuoa ud «ftc« tn>ubtt9cnie ^-mptdm 
truybv rmused(i) 0]rAl«<Aarackr«/fAf/jW fd>ni.bcirinmorrcamnnon 
ifi lihMc takbg an eidcdvc mat diet ibaiL in tcj^-iirUu^ (b). />m- 
JW^tfMW «f riMitftolN)*, morv frequonily Uun ln>m any otbir C»ip* Btkdvav- 
It it teeo in bjvtcHcal ncnruibrck. bmin tnjurict. i^Ta\At nc^iect or 
lacft of proper bobJU Injcritt ard diaeuc froccMcs aSociiiiR the |>cri 
jopenttt lead polauiing, nervous d|ipef«t^ byperchlorhydHa, etc, elc. 
(<)l Jif<c&a>WA«/<««j0,aaa<a|0tvblcb are weak abdominal muacuUliue. 
iliiclarea^ groinltt »&d the mrtuabent pcMiuee, (d). Af;tee ^mim:« 
And dinct inilation ai in fi^sur^ of the uius. benaurrbaidft. rectal ulcer, 
pveataliliii and dispkccmcai at Ihe nbenis or ofari«^ (t). Fiptr 
ajid Mhi-r nondldnns ftsmdaied with pmround IroTTTim. diminhh«l 
tccretioa or csccmivc abvtractioa od daid«, (f)- CArvfW (f«jfv» 0/ 

CUakal DiTUow. — One dlatingdahaan alonk anda spoxikfitrm, the 
former nfmenting either \ weak intertinal m^iKublurf or impirmeni 
of Its ncrvooi audiaolim. Tlui n vren in dtixriiic venous oongntioa A«mIg^ 
(dtrOAie bdTt diacaK, bepaiic drrfiotts, elc) or in ulnlcs of prDiounil 
gpnrn1drhfl1rj.nn]nuUVnl9,h}«eriftnrrf-rAlni^rg9rtOTi<^rmLiKitl1meniK, I 

Spatdc co&vlipalioa v cJianctrricnl by pfrmaiicitt iitcrcaabd; 
boDia of the lniKlliac* aad the rectal trgnent. The sraam niMy 
be of muUe dontion and invohic lhic or maaj inttaiuia] 
aejaenti li vafyiftf depvc If the vtiolt cmiQ inteatioe ii aflvded ^rvrir. 
a acapluiAd abtkunoi b pcoduccd aa b xcn In vjilnal mcnlngids 

* 7W aiiibor ha> had wivral of dbcse «««» openttd tipon with vu/3ha^\ 
rcMilu. \ 


mmcu niAoirasa. 





4|f ICClt(>, 



or In cerimin Imt&tnn; cercbfil UjiockA Moi« ftT!<|iitDtlT Ihc toSis 

i< lnin>lv«d ncd jtc1d« no i^piotttt oo Imq^cikin «iivr ih±i ihc Moofi 

I ivcmbic n>und hani baJU often 1ik« pMl drepplKp u* ibc pipr^lcBi 

I or Upf lik^ ityrmi. Uivv loravwhAt chmcurinlc fjrmpVoai of ipmtc 

roniciipiim U inumciLCmE ]i:ii[i iii liic Lrft Idvrt abdomiiul 

I nHevod by ftloo] or tficou^ This ti ^mm k vnj Kvera w<i 

F£CAL ACCmraLATlOlf u owal crannioa b pccnos 

In the jnuxie, or, m pvi^ounJlT h>Tit«ric or ncurftsttxiiic 
CftrtUai phyiidoji), bouar o&ccrs or aursr» w prrlty sun ta 
:hrm. Thtj mn «amrtim» uaadAted wJltt (irafiwml tufo-Jnunlaukn. 
TunUl Ar coujJctc Inicvliful p«xslyMS nod acvlc pulrir cfOftlaikn- 
Sitrh iituv4 freqri^nEly j^mdiicv Ofuntjclc KymjMcTni or mvn h acitfka 
and, if tlv cuadtlion be of Iuiije ihinlion. Ibc uiniaA (tiflcuJtjr will fe 
ra4.'oiinl«rvd in jiimnplt&^ to ni^ve it by rnniu or by ]>bjiic- ftfctti 
olMtnictiun ii cn^tj dLbgrweetl by the Saiga onJ sponliui. D 
lsk« the form ol ItrcifLiltHty, smtLy fJirrimbhol frvqucflcy. oTi a BMC 
rllminulfon \r\ quantity, thr Wnl pAovt^ hrfng rhmnlmlly Infulfttinii 
tn Fecal uapacinn and intkcrl in almooa dt fonna of conslfivUM pal- 
pation of Ihe tr^uiti or FV«n thr Rlurd abdoarinal vnll k mfiktat 
for the <[ctccilcin of fctsl muKS^ If aciuol obuiuoicm oosfi fion 
lblicnuwnciuiidoMlyfaiinuLi:c^, olhcrwkKlhrBymptotfiu arcloowvfl 
known i(» rntuinr <k»fripii(tfi. 

DUODENAL ULCER. Itd^m^^ haa bc«t) ma-k to ihbcoiull- 
tion tiniler g»iric ti^rr fn»n whith it iran raiHr ht ^MmgoUh^ 
Ito cliojogy b unknown aavt m the cue of cxiouriTc mipcr&dAl born* 
of ihe fthia wtiicb frcqucnily produce II It u k« Irxqwni ihan 
XMtric ulcer in the raifo of i-n or 15. o«iiis cnll&arity U 
older pcntOTu (bdwttn 30 and 4o) anil occaai«*aIly a0ccta diit- 
dran, eivn in itifanry. Ttft nvw freijticni d(« ii the upfn 
or barisoDUl porlice cf the duodm^un. immc^atdv bckind Ihc 
fold. Its fclation to the divexliculum of Vaicr when il occnn 
dcacading doodcniuD malx* h likely lo bvTdrc the ptncimilt aaiA 
biUaiy ducU. U may he ttngjic at nwihtple mnd mjiy cium a loc&liscd 
licvkonfClb by |ierf'iiatkii^ 

SfmpComa<— ThcM ckody tcombk altrr of the fiylnnaiihov^iW 
gaurk iymfiomi an tmttHy wtmtfdiy tat. Hrmttrrha^ ocaut In V5 
or 30^, M ACfod #«fy fii4aM^n4Hy a^fv^n in Ab« ivmaIbj, Sywpaoms 
of peifonuion hare already beea deaoibed oo page al^. S^f^tM 

DisxASRs or Tine rvTK wiwH; "" ruTOiCtiuxui. 



Kttnu wYJw'wMffj occur «a4 bdp dw dUgnuab amJ tijt ^tns do m^ 
ft d h tt §9 U< hoA ami «rf UMoIfy StUndty right siM^ 

ProgiiiCMli.— rntntiteie fc ow ci y k nnr^ fcUp« k mrnmrni, pcrior- 
fttkjD mnrc Irrqucnl th*A In giMr^ ul<cr. The htTnorrhAjcc ii often 
•tvcrr. orrMion«lty fktJil intl milignini gn^iiirihA mny fln^np ti|Kin fh^ 
don bttic 

THROMBOSIS AlfD EMBOLISM.— Thi< f»r« condilicn ftvulb 
uiBkn^ from 1 do\ in lite left aurfdc in cuoi of mllrd iIikmc. 
throoibaiis^ bdnf lli« coiaaion fomi uid the mfmV fn'fof'mf ihc 
«lmoiC lnv>riftbtr tftr, Tht Mimtiiion cm trklom lir runin) ■ 'i^il amt- 
sioftcni. Septic emboli carried bio ihc jrtoUrr ^rdnc^u <*/ fAe infu- 
ifvoT 4nMn ffom in ««bdirtMJtic or sqitic iocuit maj nuw ulnr anrl 
pnxkiDe seven colkky pah. tofAliied tendcmesa uid bloody dlafrhtca^ 
Babdimi oi ihtt inferior ooacnterie ulery u vccy n/e, tbc sympiom 
mai kfMtkiR ibcmiichts to ejvct dfagncvb. 

fnun t'lii n cnrDnion vrmmUr^r ri>Ttifp^iJLlt"n, ^KX^urrfng \n h ^itr^ |irf- 
ccAUse of the idtuieied jnibftonarr cava. It ailcdi chiefly the toircr i 
portion cd (hr Deufo ind waj cttrnd donv^rd even to the rcdiun or i 
BO a vmriAbte ulcnl vpwud- The ulccn are Irrqeulu In »liai« wll)i U'leert, 
uAdroo baio uid bhj^lil red mftifpnift vhlcii nrc uxiuJly uiukmiincd m ' 
otcrlappC^g. Tbcy rmlilr finn adhr«Tofi« and hrruT «rMcitn ]>rrfiir' 
AK. CHbui^ i» ih<iT Unilfacr io mctrcie liic^ initstmc iht-y may in 
imre buunin h^ «iri peodxjcf dcatridiU timoiit. Diappoiii It tri- 
deal froco the put* blood tad inberdc tMidlU In the »loolv riiuocialed 
villi locolttcd poia and Mnderrwsa^ and. unuUv, > pnsdLuncni knowa 

SYPHILIS OF THE irtTKOTIHES.— Sv{>hililk ulnri forrnHbr 
IbrMltctkhigafgiRnTraUoaiiT, i»ngim]tal3>.iTiih4ysrniillmlf^i^ to 
Ibcftdiaisied ront,diicfly bihceoloA^rcerumoddiuiui, TbcTpr7«cala 
banon Ittf pppfflnuue with well dcfincfl mirglnc and an faidurotH bine, 
Iflecra are aa:«*kiUNl]7 ct«mrd in KOfudai^ »ypfcdl[» and a fonu uF 
alceradoa d ImlHinJie cauMtiofi l^rmv^l "Kirk"o<runocf»aionailf m 
uMweetion irlih ilreocheuwf Truka^miiiMXunj.aciJmiiaBud LbfUkc. 

IfltMtionl Panuitf a. - !*<v fa^ 49^ 

BITTEROPTOSIS (Glteianl'i A\MH§Mi).—TkittyiiJremfnprtsBtU 
a fi^aU fmWiVfrf IJk tiathi<h, i'liafintt, kadneyi, ifirr and jpktn. 
In ooe trpt cfauwtcifjrd by aWnot of aBh^eeliiG fymfitivu, fhe 
cemdittoa la asioaMoJ vilb e^rfrrmc ndjantkin uf llir ibdoetioaV 
valL dUm tnm ivpvMed pngnnnfice or ftcuimf^ «Mi^». vW^\ 




utoiCAL nuoHoea. 

ii> "If- 



I often inrolvca icp«nidon of 1^ recti Jb the otbcr. iJic 

I condition in l«M«r ilfgnv k u*od*t«d w|i}i martc<1 fitfimstticoifr 

I and ibc viciima arc umioUy joung. tluD fcirulca* Symptom*. — Tk 

I fint ffft^fi tj fffi/ fff auhfrtrd rignt, ikt nffiW of twhjaiftM tjM^ 

I Inutn vifl th? nlisfiicr of □ompUinl in thr funi^cr k sinking fn ooaiiu 

< wiih the npparcnt dlAturiumev oE normiJ rd*t[c4tf^ the ftbdoiMD 

bHng relA7«<4 Mid uHtiaUy ihtn. the tionirh If Inilattd b<fag 

I vbiblc and ctcaiIj dbplaicd, while tnl<tfinad pcristUsis and bo 

degrtr the gairtric vavn mir be ^viilrrt If gutric diUtalton be ptcv*! 

it b Ukdy to le tliat of aumv. the pen»iatai lacking the vi^ipr of ilui - 

•een in pyk-ric »lc(iosis with ccIju^jl P«lpoiifia tho^^ d 

fif the kidnry (srr moniblc kidney, pafe 365), Ramellnmi « 1m» 

dbplftccmcnt M the liver «4id. oc««JcfluJly. deddod nocbilitrcJ ibc 

The cdbn is ti)probi^*M m tnform a rnorror Un jvrfect V and no; 

^ /rJf dj a fvrd ctoaamg llic abdomeo ol or bckm the naivL In ibc 

wcond groxip liirre ore iviaplonii od nervous dppep«aiL. dmocinic piM 

unuUy lumbnr. &u' ofitn uura4li<u, subjective eplKssirk or uabfl- 

jlcti thmbbineond. in f^horl.thc combbcd phcnoracTu of sctvcvad^ 

fVfi«t» »ni! mom «r lev pnnoimtcd fieunsdwDin. Xol only do 

btqucnUy Gtid the fint type of oisc? bckmg in iTmptcmu bat 

ihotv eif the second trpe may dct-dop only »ilcr ad exhaiutiog JlMaih 

KRne jirofound rmotlonxl dl*lurbuire. qt t)tc di«da«Uic of ibe d 

by the phys^tJ&n- 

APPCTDICITIS,— T'Ar rtmtvkafilf pn>\ilaitf »} 4^ptndUi$i§ 
dttfOM ii Jm mertly io itt nbttii^iHen unJ^ €&rtt^ pcl^eUfy 
4iid Urm ftrUfmiAt vW^A f^rmMy arvfffd its t^tmifary and «Mdl; 
. SfqiKni< <jHi Ic ■» bftter kmrwkdge oj Ifu nn^if 9} Momtmal 
Nowadays^ SLStdi; from traumalifim antt |»«rtorsLlirkR nicer of the 
•nd dmidrniiiti, m tiU j^hiaI t^ritcmUis IH nre tn the male 1 
malt of »[)iJiCndJnti9, tlie feroikLe.ikppeniijdtb ^o 
pte<bmii>anl Ittitigh the |>rlv[c suiiclmQ ihare the dubious honor 
PreT&t«Qce. - Aprendidti^ caujo upwftrdi of *%of tU death* jatbe 
Unitt^d Stai«, X higher morulfTy than b iliown bj llie OfttuUet of 
foreign r.uunliies. Etiology.— The dlscHK i^ mem prcvslcat b ibe 
youi>g. being tnottc frf<[ueni undff the tge of jo ud eomfiumln*^ 
nrc a3 n pnnuuy Icaion in pcr^jca af middle jiCT. It i» lliv'^> ivsre 
fif^aenl ia ih« mak Una in the CerrvUc and in tlie Ulter b trequenliy 
amNwrf vilb inflanuutbrt of the prlvic TiAcm,* An fndtacnet 

* DT' a. MeL«rcn ukI otbcr «uTKcon* of wh!c cipcr k ncc bdieve dn 

Rulf pr<d«imDUiiev t mjrth* 


DPTltWfl?f m ~AI'l'itM*'J'CH'iSi 

1M> 6oxhi pIk.TTi A put. pftnkukjij la rrcurnrnl «uo. «iiJ ouugia- 
MTi i« ■ fftdcf. upciMUf thnt inTohuvR hard miuojlar work or 
vm tmlm nurli lu UAfat^ 

5fAptomft.- Acute ■prrniditJtift yidds ay^P^oov vvritif- uriib 
« rumn ind ^ittnt of ihf* influmnatory pmmft, but »ll i^ovfng 
turn vcU dcAned dsnctcraticB.. The jubootf^ md ofaAd ^tfAfrrW 
n>i in vHiidi the local ctaogea an slight r«t>* ^i^fiJ ik* definitt 
>mptoms or tiirn^ v, ifiifnt^tumauiy umf misUAdingty icnat imrs, 
tie doklf dijuj* fcrm a uccvcinUd with aa oclit^ in&^mmAQon i 
hI MltniEon, ofim with crf«di)ni of rhv miioitt, nnd prmJucfA 
nallf biJl not aJwnrs mafkcd tymTilonii. rvirulcnl uid ^n^reA- 
a ap{wti<lKi'Jt irr arh-anovl form* of th« nmo pnmary lf*Ion>. 
bdsmimd /oin. Mvr tinJ /f><ufuf[i kitdtr%$ii «fc tl>c c»cDtkJ fcaturts 

ftU acucc focvtf. i'afJT of odden onset a$t4 c tatdemy u^ Uc^iu 
idf wJUifa 48 hmini« luually <aHicr. M a pclnl tcpnawntlnj; tl>c tiller^ | 
ctioo of the o«ter ed^ of th* ri^ht rmitt wlih n Iti^e drHwii from the 
itrrirtf (iipvrior lEat ifiiii« to ih^ mnhGlkiw C^^Riir^"'y'i< |-Hr>i^ mhiJ 
c MMKMied hojiiicJ ittuifrrtm really ciikc ihc dia^cw. TAtr- , 
^Uhoot few % pc«il>vc dijigao«& of icuic ULpprDdicrtii! ii diAcult 
)t case* occur £n whfch locd tad cren grencrtl imftonilis *rc present ' 
ilhoi^ trvtr Vvtm^^^ ±ini Ci>Nfflrfjf»M arc luutUly mitkMl (MtvvMi 
)H4rm rtuy li^r^' SLirrJtir-t Phyrica] SICDK,— Kar^ in the diteu? 
leiv uv iMne 0I htsporlAiicv nve tbc cvklcnt T«n aad dutrrflv and 
ver. f^f9$£m nuj ihow JfVM»iiJ rrjJiftiiiirv (imatulir rigidity) 
lih ov mikiwt IcndEnicM b ifce refpon of McBiLniq;'^ point, h^i m 
invy Mttr lUbu jjMi/fDBV » dtUy^ ^trt 94 f»MiifT ^ m^f^, Doubthd 
Hy <vc» tiudfy McM<ifi&Klc*s niuKeufrr. tx. fijttiiun uf ibc Lncc 
I inTwIiin ud wUng pttiwii bo atlcmiii Mi-tton (if ilir ihj|£h oa tbdo- 
OD ipdntt ri^KMPe, whfletbeunoccupErtl hajitl palihuu-« ihesliileiim. 
utuiooai bypgie aU wA of the nth dorsal ncrrv auiy be prrvent 
he nH»ifttion rrf musnibr riglditjr umlcr jmn-iTh«fn in pofontlTe 
tics b i*kl 10 ociMT bsi ever the exacC «Ile of ibc pc rforttbri. Ratai 
• tifffimal txaminektm moy jititl itHfioHoKl iw^firmc'VflV m aitMi/rr citrrF 
W »&piiU wvcr b Lfm^tf^. i^mtt^iiin iti jf »>> »pej.ial value acd 
mnijfiitfiw it DCplnVi Ai t^ dJMiM adTS&CM nquisiU loal ten- 
Eimefli devdopii there li ■ trndnicy hr The f^timl lo <hmir up the 
C of the ACEeded Mde, dcd in certain cuu [vlpaiKn tn&y fcveol to 
:iuiltoduntion.scinwiinrv«ui tfv fc^^l regicn. im^ire of len jutt above; 
ogywt'* ti|9uncnL Ittiddcr imiJibLlity l» ooniAM aJkd. m the femaK ' 
Lvadv80>Mt of th« appanilafG* by bnammaiory aflheiionft U ii«L\<MraC 




nf-i '1 mlMt. 


I tii^vr Ml u. 








P«rCoratioa aod General Pttiloaitia.— T«tnpmlart nuy be le« 
iir nlv4rTii, lUr \niW tLm> ihr |«iii maj dkippcar and ihc patWnl 
Udirvc hiniHif ht-iwr, tiut «iiiin ihc Eaocc wiuna Ibc Hippvcfilic 
ruT. tbf !»lu1iimrTi It ilJsirniliMl. mockmlnM and tirlktaigly fntMuu. 
fi«th ktMX9 ATT dfiLttn u[>. ttic iniUc bccumtt r«pid> vnnr. osd jmtSi 
\hv tonf^ dfy, /f thoM rwnirr f^ fflrg/aMH tk^t in lAr Mrft«r jfVfui 
rj/ ^ppmdiciiii the paim amd trrtiUrrKii may he fcturai. oaJ ikal m prr- 
fiirtitiim and grwrai p e n tantHs the patient't lensahoni «hJ tk4 Itmptrt- 
tttr* mt\\ f"" mtiVi mntrtiiiirtf^. 

Diflvrtotiiil Dic^osis of Acuu App«adidtU- -Anr aUtck «f 

»mt« abdomtna] patn ulimrU-il liy fni-r mhiiulil nl anct mg^rti apptrtj 

diU u tbc «AUJC. the suddcnncA of the onset bcbg in npotUBt 
liwugh not ab«olute duCiiiclioa lu rvgirds lyphdil, (or whkh ll !■» 
bcr» muiy tEmc* mJ«lAkea. JiMof cc/k mir pravc detqAivc a l*u 
fonius fini, the >a oJled Dicd'fl crkrs whidi uvuiUy Ucfc Ihc uftkuM 
lonUiution of upfirncliciliH. SetamUy. tht puMgr of caJiufi Uivnu^ 
ihc urvt«T aad npcdall> sudi *» ur lemponviLy tod^Dd in iM 
Vift furrottttl prtnion. The rfcognition oF renal colfc vboiitd 
<1j£rjiat[> by nasun uf Uic Ijuli^ uriicin^ inun «>vcf the kh 
lis itiblributioQ^ Kunhn-rmorv, even the ureteral (aAc» anr usUAfly 
deAr if the untie bcr euniiucil oj ii atumyj jA^wU W teiort any oftn* 
thm it mnderbxktn^ SevenI limn in ihe Author's evpcricncc «och 
pftlier^tfi hkVfr nuTDwIf eAtaped Ihe knifcL GaJlT s^ne eetie U uatalf 
Jdinitrly kKalLJccd U^th <u regards poirila of tcndovieai and itfcncd 
|iaiQ inil pe^-Tf /mioatiii preaenin biktml rinfdilf, bj^gatfrit paia 
and lucaJuinjc syirvluuiB per vAicfiiaco, NeirtthelcM acair ttM m 
07anat mpimmaii'm it a ixiric lituaiion of an in^amcd appCSkdlK 
itmj ttuapiiioie tAe di^iicrv'sii. suid a bcal ei&mitiAtit^L b alarapt nem^ 
HIT >'■ women. Strain fuialii^n and tntiusuacvption difcr from AtH^ndi 
diU in the fceal vomiiing oi Ihc former and bbody unali nf ibe Utirr^ 
ProipKMia* MUcl taurrhal caica recover wfthoiai otxraUun aftcf a 
Ver diyK* dlneai, tboat going on ti> iuppufation cn&jr rt«al( in a gnwial 
fierilaorlu. 9Uigicne> or perforatkni allended «iLh nlnutc ptuniknc 
inlbirnmation in rctnole re^oiu. one of which U the pcriraia] Ujuue. 
rmain of tht ncuie «u|iiiimtiTr ca*r3 nipturr InTo the bowvl draJntn|( 
ibe abixtM cavily, and may show a nrmarkal^e fracdom froBi rvcvr- 
fan<^ Tht <)tvaliofi of aur|t(cai Inicrfm^nce In appendtdtk b a dUb* 
cuil flQd bttpuiUnt g»r. ^fj^KfJ f^nja/AjJiW jJheaU frf lAe fmiiriiiMf 
naU, attti tnfgieat jWifwiif i^nJJ iW'n'Wy &f eettfttd. No matter 
turn mild tbc ouc. a xcmid attack usually calk bn ij|)tfatiirc isler<a- 

NflBMBS <m noE CfTcsmrKt— ATTrjnnaTui. 


ftiC* tta^l ifl iKmc who ftvt iTLt or whiuc rl^trrt xakv ihfm lo rPmot« 
RjEkmSy a t^niAiT or ioUnal vpciAlioJi sIhjuIJ bt ihc iiiTniiiiTjIr tutc-* 
CUROJIIC APPKnD|ClTI&-As phjiiaJ sigw mnf be wholly 
bii:Luif> lail Uw i^TnptoniGitology lUSTntive or cHwose of otlirr or^ni, 
fAf dhijCKMU iMMdify dtptnds mpim a defimU kithry af atl^^^ienl aitOf. 

fWif/' **ptsfttigi€^ ct *'«MPifiii irouUt." OccuicmaUy thert >rc eo^ 
hfHcd nod thkktDcd apfjcndiou or ok) in9»jnmaitc:ir7 isbuk* UiaI cnjiy 
be pttlfttlod. Quite ficqucntLt that nrv mild but dc6iiitc locnli/injc 
cf»l|Mi<M and dif^l Inrr (99.5 F) «i Ihr timrnf ruminarinn. Sug' 
f^adrt lymftpim or*: fain ovet Ike at^mtu-k. ^M Utiiiiirr /md itjnhffkitt 
itKtmvd bf affnutif^ rtakft iApW fry toaU pr^awf/; hyprr^niuna 
Ptsr Wj[ib tJit vi talmt, Ml er fniiVAy fain vn attfciit and fmin kaso^ 
d«u4 wtt vitiUi ftfiaafsU in Ikt UttK^tai rtgwn (ubftnictive vlbe- 
ckoi), Ri^-uiU dyvmenorrhm k^^lng an ttOilcHljiasiiujcRatiniE 
ftppciidkiti& dinumithfd pewr fif ctt^nutce «Ad pffot^iU moinulnihn 

%n btqtiraily (irr^Til sacI ji (fv/f acking or #vrri fMiiky^ affmiU/fiiU 
p^n may cmc on lU f^ Ad<Af i»/ tH(f3^iifn. Ei aboul-i be bcme in 
mind iJui cbrrmk ap^fi^nJuitis ir frf^wntty nsvuyiSfd 'avik m^-'ohlf 
kidney, tkttmk mdigalmn, vtatinate *tm3lipa»iav. idkma$me dittrrhra 
mU MrtMfwiim amd nmc&mt (mtmhruitnu) <oiitu. FucthcTp Ihni 
^■npioiM of AOnuHtm ituy l;c nuj^cil liy ait iilil Apficjididlii with 
deiiM ftdhfViDns. A itMSKwIul c:«u»ilr>d LibvrvaktiiNi hw amrtncfd 
Ibe •udbor ttut IM tKr^prto or intrmilhi 4-an hopr lo mngrtijof %\\ at 
ihcflt cues wkhout OD cxplontonr operation. 
DiOcrtotul DiagDOdf of Chronic Appendkitia. -This mud 

dcpcnil ufi llir litliini already |cIvt:ii- 1ji nhMt irHlamo* tbr |i»nl 
birtocT vnd the ftrilie of «uihA<^i? ailUrJit arc th« rlclennininii^ fkrlrra 

P <^> 

ACUTE PEIUTOHITIS.— ThU nuj b* i«V4i< i«/f»v w ^m^wJ ud 
it» c«uK9 nre loo auoxnxii fur deuikd dcacriptiOA, but rtMhc tht 
(■»■ lalo frimary and sf^andary j^noaps- The to-called phmary or 
idkipAtliJc iicntuntliii b a tlul;wu» d^okiil cnlily. ^r((*n<fary |jcriiunhb 
■MAU «a tsUmiok erf tnA^mnatioQ (rem BAy flimctiitv 10 the «dj«fent 
p cril opn i in, Tfau h mfty ufae tirmi intumaibm indudjng openiion. 
(rmv esocBwm, b the Nrcrtr infAmmalian of the inlutmol ir&ct, 

• Im rhndna pntnary oprn'.na u wui|l]r Adf^ffd rf the dtAgiWM cwk 
be mvlf wlihTh itir Unl 7f Virin- 



-VI r J««t|int 








from pcriontkm due lo ab«c a or ulnr, md from chronic silnMatt 

such a* CSQCCT vul luLxrculnu*^ Funhcnnorc. tbc kncrux od vilklh^ 

in cvruifi chnnic iLw««» sccmf lo render the peffftooeuM ko nfilif ■ h> 

to iJw aclhin *>f gprmn Tlif cviilenrf* of mfcrflon ni ihr prrftfiitfUH 

ire cxircatclr vj^ricd. ccrUin cuca uavcittnl w^th jirjCound coiUpec 

I aad dCAtb nibicqiicnt Co ibclominftl op^WJon ihiyv\T\g no Inkn mtf 

I prrhifii^ pomU of omtEcslioix In uicie there » Ijittc Quid or fibriiio«» 

; exudate, in othcn a lorfEC ftAiouai of fluid uid cxudrd J^^iiih, Uw fluid 

bfing M.-r[Hl1>rfnouih fivruleni. ]juiM. or. in ivouriJ mfciifoD cmrdi 

I ukd toi&Q tub«rciilou« OMS. hcmorrbftj^c- Symptom A,— In 

I peritontib of ihf pvrfnr«livr or >rplf^ (ypr. Ihr Jtuiei «rnn*ra tfki 

I HippocTtilK iype. iherr is usually ttvett ini'iW ^irf ami Fvidtnne of 

mertitd firosSriili<m nr c^afist^ jf^ft may ht pmrifii by tkids and rise 

ra]jiit]> (If A tiJi^li (H>L£ji Lir ihUl ncd /rv<r and ^h tr absent. On- 

liHVffBJ Arf'r i*^fr u sfidom seen- Pairiful vomidnj^ and ftrqufoi nic- 

' ttuilkiD ai« rommofi. The «rifi« it laifO. inditativrh ir mdrl^dL ll« 

^iJistf If stiHfiJf unJ fim^, and t]iir fesiium m n ^^y ^vvof . wiib Ibekneft 

dtavn up and the jA^f^^Hf^r imnr, wnm^fy ttiMmM but ooculonallj 

fijil. llw vimiftiJ w yc/^'it tiid kilt afjifttJ or Lticr jiutc ptca or ctee 

bicnfniah bUck and nl Jr^ii/ £'if«tf- Wo^uug la rapid, disknaion tcodt lo 

I tacrcaar. I^iu|ia»r lirinK nuirltM. and ibcie u xtmtrJ tesJman oS in 

extfeme dqcrof. It should be eaiphatir«Q>- sbUtd chat obtiterotioit oS 

tp\cn\c and hquTic dulnns u not confined to pirfenAm prr^ioeiirii 

bui may occur id any uir^me uuc of tymfanJlef. Dulrxn iM the 

fiatiki U usuah indicaling fluiil, xad ihf d^#cultlo> of dia|^<«ia la tbiat 

i.ava are chjcilir idateij lo tlic Idenilljcallcio of the ivinufy laiciL 

" jyyiftffifof ^vH'Miiiii'' asa; how«rer prodoca a tjrpkBl dmiod fucUnv 

an lEmpeukin.bui fever, wiry pube tujcl iuiJitvi uiovav arc 

abacnt Obatmctian of itc bowet <£en Krefli didicuJlf al timcfri 

denandi a caicful cnniddeTfttkin of the Carfem auied on pa|#' 

I Ruptured tubal prrinancyp acute Henvon^iapc pAncreailtEaancI vaoovi 

I AlhCf ImIotw mar demand the «ur|rr>n'» knift for itflcNtitiatioiL 

I tX)CALIZfiD PBRtrONni6.-Ia iTie mak 1^ moat frequent 

cause of locolLred pnironicia la appendicitk. in the female tubal 

OTOVinan ifJaTmuaitcjCL A great uijicnbcr of lootlixied InfUnnma- 

ileiy cooAb'ofia of the vxaccra fffvt tm to ttonlBcd areaA of per- 

I fioatiit, the drgre« nl btflaroroainry change and iia eaign depend- 

iuf upoa Ihe porifnary cause. Ajn cxieoded itaciMkn of tboc 

forcu ia uut of the quraikin. Tkt ttsttf /criXruvuM. 

, uuflt iccehre apcdal altentioD beouK of ha frrquEUt 

nisvAfiis ot-tur cwrKsninw— Tftrrfltfrns , 



meat, jb unpMUaicc vid tit obscuHly of its ^ymptonu. The Icucr 
OLVfcjr b bounded b (mnt hir thr i^tink-h^paTlc omcfflimu the ftnierloi 
U>TT vf ibe icretl onncfiluia uid ihc lEomtch; below, by Uw uppo 
t^jrtf ol tb» tnantnt aMto-oeloBr lail ritcn^lft tnTrn lh« ifilvnk lo th« 
bq«tic fiezim ol the cciloD viil ^m Uk^ liiitu of the splrm to ilr for* 
luncn of Winedow, Above lica the twi^^rsc bcfiftlic £sniTr mnJ that 
poctinn of Ox dUpfangn o&vpftd hy ibc lo»er hyer of ihc right hepatic 
Ulcnl lij^aiciiL In ibc pmeacc of inHjininulkin Its coonintinicftEiniE 
Apenlng teding U> the grrftlrt o^irriy (^inLmcii of Wln&lnw^ msiy hr khul 

icol ^UftdAnl. ThiH i» mukcdiy ofic^fi by inflition of iht stomiidi 
wfakh tends ID obvcufe or oblilcnuc ihtt duU noiif or cim the {olpalitiu 
oittlstc of dw tuoMT, wkd oa inflAicd colon docs not cma it, but liet 
bdow ii. ThlA ta ppoprrtr titovm «it ''nibphrenlcAbsceMt*' ittmoA 
frequent cauc bcinc ptiloraiia; pulric uUrr. J>ur;iicii«] ulcrr uid 
ippanilkn) ibam* ftcvo«nt for neurit ^T ol ih« rpntainrji^r, Dlf- 
fcnotU IKftgDOAis*— The JTM^ivnu ar< ui7iJiZ/>r dAni^uNif(Uimif«rf 
ttiM /oi«, tvfvnfiaf , dji^KOU iind m/m^ ^/ stfrit. The JHii»f ntay &« 
faifoAU In mmc ponionji of the upptrr t|iMintnEt(. cysUilct in Jttt. 
■■ytuJy tfAiKW^ ^ jfamocA im/hUm, onJ nt*/ cnmtd by en hfialfd 
oaIm. «Dd wticD Ui« ftCAflnulAtlOB U iinnudiAtoly bmfAth ih« di«> 
phncm tbe iym^A«u t^ikmfiy n^tmbk «m^yrmd and lAe ^it€44 
■BffjF ni|«wv JjbrMi^A eA« iutg. iSu pits ttfpraritt^ in ^uanHiyim tlu 
j^iiftipw, <Sa ftlao hefntk bIhixsw) flic AuthuT bdlcvcis that icudi 
cues mmj ia many bvuans be dLffcKrliilod liy iHc obvcncc of rv«pf' 
rativ^- liUrnI dif^Ufpmmr ol thr hi^rt fnw paRP ij4]i. // flfr ftf frrt- 
tni, fntunKifturaix ar xiwJoAa/. fruf jkttttd b€ <vtUy ilittmx»uM pp^n 
X'Haj 4i^mim4tifin by iht 9ngk posiUcm of Uv diaphrcgn end unitT' 
fy»9g lAadnp. The mi<naHi.T m ihb ootiditicHi b pnc>tn]cu»rSc^+)< 
CHROOIC PERlTOnilis.— The pljiitic lymph auadatcd viih all 
pCfkooca] InilaritmaiioiM. luiiic orchrunk,teniktofonnad^LadnnbiiniU 
of fftvia or le» cstcnt, d«ully and pennaAvacc. and movable ri«ccra 
olM dtoi^ afghJtinai«d aurfao* apart to form Mtt bandi. Ti ahmild 
abo be remeoibcred that in any canJili^n iimulnimg hoai pentoniiii 
Ikt aUowimJ v^U liuki tht prrtittnsi gnrral or Ii<(atiBf4 rigHiiy cf 
ihc Inu aiUwnt. Fn bolh acute amI rhmiilL Tiiina morootcr the tju/c 
with nhick tie indamsnaltoA idat vprtJid Ircm cerilfinnim Ut pleura ^I'txlms 
and vice vem rmoI be caheti into acanint. Ah hdmiind Owen i«y«. | von 
"the penCoDcuni acta is inHamnuilioD much like an inflamed' 
jolnr" i.e.. il seein fundioTial rot and UexqximtuVf terL(\nk^t^entt\ 





waacMi, mAcmoi.- 





mrf ilbr /«fr IAjJ pmiurt n^M rtii^w Md^mary ta^c u wtotoaW* 
ia paiiomiUs. FurUitr, aji in (tlrurisy. u*utw f liilMii i»<iy rcMaf vnti 
«/ frMtm pnrticuibily in Uic rcfpoa oj die ■ubdupbnjpu'''^ <>nE*»* 
vkiffa mnvp in tn^i^ntfon (chlrfly ihr liver Had iplnfi). CAmmAt 
iidA^sbm^ m ihc fdno of fftbc bwb may canieo oAlesiinal ob^trocCkn 
but tD the ordimiy fonn Ibey nay ht ayaptomlcH or px'f rit« \a nu»< 
leading and InmljIcKuac aymploms. u m l»o oib ir^cmtly tibaerM^ 
by the author in which a cbrcouc of pvAdidtiA wiUi amle cstaeofaatioA 
vu (Jtsctly sliTLiiteicil by *ii cxttnhlvr itdhr%ran In iin ndgbborhoodL 
the appcnJU brinic nonnal- 

roarktd iliickcnins wiilii™i <.ilcTiii\f adhiHions *n<J M lifnoUy au«a- 
«tfd uifA htfdHt titrk^sii. itJ>rf tartly \uftk tkr^mc ^lunv CMifafllPL 
l«m(vi anJ iiAiQur ft»nJiiiini», The elTufiiikn is unuUy imaJl, Ihe ^- 
Kxt% n-tn>' br miiLklcJ iu Ihc ihkluiwl lAy«t» ami the pchtoonua nay 
!« Otvt«1ril inii> several cbajnbcn. Ehrinka^ <if orgu» may be {nr 
ductfl an^l Ujc idkd onicnlum usually forau a tmuvene riimwrflJ 

Iki Itmtw bordff of lk€ rUtmafh. N^tJ4f gmHk$ stmuiahmg ihk«rf« 
IT nitiiifnjn/ tutJuIr^ nuty Ir firaml. 

TUBI^RCULUUS PUKlTOniTlS.— Thui condilkin Tiriwcaacily 
09 i\ii }txt\miMiiiry Inioim* thtrs Mmg an Oittlr miii'orv. thrti^ie idttraijwr 
and tii^omt pifvid jorm, II may be prifnwy *>' atcoinlafy bcint iic- 
qurtiily usMiatnl with intnluul tahrmilivli or dknuc of the Fallop- 
IftQ tube* (j« se^'ri of fululU), Titt ^rMteff iv ifmmtl ^Mn waoy ht 
ffimahJy i'frt«oiiyd, lTi« Uci<lcncc a* nganlit lix im into 1o ooo in 
tlwrnaJraiEunipajni wiihlhcfruuUr- Asnganfavjsril nmcalfreqQaM 
in ih« ^nl, 4lh and 3 th d«cade, M ivgu^ r^f^f , moi^ ootnoMift in llit 
iWomi ihnn in the wblic Tr^iunaikm. tinboEU of ibr thw ar^ 
btmia arc uac<iaic<^ cnni^iliom in mntiy cajo. Symptonu.— Aawfih 
rubermlodi rkrwhrn- ihe dkejur nwj he tymflamktt and ^ iitw- 
tfffy Jmj |iMittfwM(Al iAiift otkft f^rmi 0} prri^ffniSi^i man nnjy ifcr 
oliMMndeoufwvccxtnordinarilyMvrtr- /n gffw^ tlutt u fc w Ar j a wa , 
/ffcdJf« ri er Ai^Mt. and a Imffnilarr wmtIumj tomHrmom^, trfarr ofkm 
Atfik m iyft- miitdiy «/ '/i/U m"^. and. n awjfrai^, fifim hMsufr^aCM 
OidMt. f>vep pJKinpniaiian of ihe tkm ht MnadknM nbsmvil anl 
Immon art etuvutitcmi Jitf A) imitmiitm ismJ tftfVf4ra<iiiTN i>/ uUraiml 
£aU$, twyii^ fjiiui^t ttMd tttiA^nml tmttOtm, or. in ditidfm. I» tmhvgfd 

DlffOTtfitial Diagnoiift,— Caae« wiih acute ocud aod i^lcnt 






lotti mmy be diueoojfajabk tut lul>crcut(iufi4 thttic wiih ccnlinticil frvrr 

uc dVcETOlhftd from ty])hoiJbj- lk-«tiRtnn-ll)]rWi(blrm.iiLiri)iiM Vhftf>j 

tl>c oHMjfiutd d«vc^]iTpcncnt jtnd prcdomuunoc of pcrilonctti hjTnptomOi. | ' *" 

Ac ik^pr onV Ud. Tk€ prtizaet of oncnrdtik grttiiiy ojtiiti diafm^i). Jumni tnd 
IftiaiMinituiOMftiugpalh^fuiulyBndpcrMmdhistiuyorthcesritta^ f«dd>ir. 
of tuboculDitf politunwy, iniMtin»l nr lubnl »}«npUiiiw uaist dillci^ 

CAKCBR OF THE PGRTTONEnH.— 'Si-rord!tr>^ raws no»<f no 
spcdol description. Uirr ukt the form of growth*, jfcncrjJJir rfiitribuicd 
uid wrying £mik the milibiy n^ule lo Untc umLilifaiFd growths 
Tbe «)iiiti)luni b frn.]ur»tlv iniiolvcd vilI fonn» « jjrculiar luriiLir ■» 
in liib«rtulo«i& Prinury diMaw U vxtivmrly nrv and mu^tl ofl«n 

Dli(B04k-— A ponlnr dk^osis is <tury In tcfondaiy cclmb if rhe 
prinurj VNnr be mJi-nilvA, but U ftlw^ni dilficuli in the nir*r primary 
ivmnu indttd Ji prwtivr diffcfcntiatloti h h«dlj posfivbit vithoui fxp\at^ 
■lion, ihc fynptonu bftn^ ftlmMC juiecitial wUh \ha» of liil)rTcu- 
tau& ot rcbfEUJcocciu iufeotLKi in cn<Bl inscantvK 


IccUoo thruiijEh iW Kflil-^Jw'^^tr a"'' dinlj isd.t <Kn'f 'iiunr *>< (Jim dia- 
«Mn, tbou^ L0»* tt«Ji, \t i'jtwl t^at'k into th'< (niiHTi-,i"( l.y oliMruc- 
liott la iu nonul oulftfw may prtir^u^L- fni iiitciuhs aikI licnjur- 
■higeta It iwi]raln>beiivroltcd in upikimiui, hy traumMutn, ot sec 
undAffly, b ihc cirentton of taftimmsunrv profrsHs front rTei}(]it)artfiK 

SynptOflBL-^Tt^fr tlruty ritm/I^Sr frwjortxhim fartitiJiXfly ik^ of 
jMt^nfci/ or (otlTK «kfr. 1^ vnsd bcinjf mtiiicn mVfi ttuimf celiiJcy 
faiM in Mk r^offH^Htt «iMV*ciW ^Ih tviWiij and <4iiiapse^ nitfa 
^if^umi £^f«jflrk Avtfif];, b k rridcnt Ui*l a poiyiive dinei^osdi 
i5 often Unponbl^ The muimura of t^ndcmcu may clearly finltov 
the ouilitkc df ihr ]»nrrpAfc ami Therr may hr a vttj^gratlvr hlxiory of 
ADlccedcnt dbcar ud die fsiJt-tiUddT-r. Dift|cxi<»l«< Thr iLitijiufll* 
nmt b« burd upon tbe nr^^ onfrf with p«in amd vomiLmg, tympTAnii ^ti'ilcV 
vl cWJd^ And the npptanincc of a fixed Jum^v cnnrvpondinjE 1o tbc |)^^|^ 
pooHioQ of th« »S«1cd Cretan. The diajcn^u.'i U uiuoUy though noli 
a1««5ii nijule by nplnniAQ Kmfrm Tlif iirlnc m^y iA\im lnvtii!bw^\ 


l^TQUD ahn inrntinctii «r>tb basic kod Accuic. Gknligiu UtAUaen* aS 
Ifae AtoliB vith h^droffc^Q wJphtdc trA vv^ponliMi- Prognocif.— 
RecHvttT b flic cnvfXiiiR, 

K*«t).^Sap[aiftlnv pttncrraJiiii la Mttocntnl tr'uh pfHimiaafy dl< 
gcAJtc <lbtuib«ACie. icnt, pcmbly of a KpCk type vitl vrbat b nocv 
irapjrTarit bv a fiicl cjiicTitinc lumor 

GANGl^krfOUS PANCREATITIS may mull frotn bcDardap 
or mnily vujipuT&Uve inrUmjnitiia&. Ic hu fto dbikipiyfalQ^ ayvp- 
tom aAid« fnsni ihmc of ihc irrimjtr^ bemnrrtiSKfc or srfjUc pjino' 
tku> foUovrcd by tcUapoc md licatki ia a few wnks <a d^y% IIk dit' 
Imctioti is mnilr post mortem. 

CUKOKIC PARCREATIIIS do«ly it^cmblcs hUk>kgkmUym it> 
Iwo fonm. ftttophit aad htpcrtrophic dnfaoaU of ibc liver, tbc innatr 
tiittAHittn It frc!<|iirniii' ASKKbif^ villi cLlal>rM«. 

PAIVCKEATIC CYSTS. -Tte <Lkt diancteriMia ut rvcvinM 
coXu uiTKUilr^t uktt unm. nimillng nnil pKtgnmkft aMan^wal ■&* 
icRuoa. i:l>tonim. cmsduiioD and i fiiod nwdoe tamw. <}Mx in 
kd, ftnd lytng ahtv* tk* imfiaUd taicu amd bdo^ AU Oamatk, 'i'bfv 
nuiy uliAJii ;:rczil bier. 

CARCINOMA OF lUE tANCRKAS^-PrimuT am^&om* id 
volvca unudly tbr betul of \ht gUod. htrtuimtis or dfrrci tnvAiiiia d( 
Mbcf <0Vka» U freetuioit; the cttidhion ts nrc S|nnptoizu.— Tboc 
an cbicily tbow of f^gtttih^ emanetiim. att^rmia, tnir^/iabU dyiftf' 
4M» and {iWif «r Mirre ^fig^slric pom. tht ifwlf «r« tfkm it^ht «ai 
^Ml>, imifiiv fi^ns «; ingaUd nuoJ iMy iWfWI from faulty ponovitlBC 
ttCTdiaii Kud joundui; and udt«s ui? ant infirtiumi^ The tumor b 
Jtxdkn onlcfls the UJl itf tbc panocmft be the pan imrotvvd Aod ^j* 
fo^mla. Jikuadlc« uicl \-Arinui pmssun ^mpiDmi may be |irt4iAi 

PAHCREATIC CALCULI.— Tbc pai^ ti^und «i «pic«laic Jtowi 
are, in nrr miLmcM. a^socialcd with riolcDt vplgMnlc Cofic Mtd ntftf 
be fQusil vn tEic sloob. OtiKDuily ibcy pntihinr «n intrratilUl pan- 
enstiu* «r lend to Uuccml 


COT(Qi:NiTAL ANOMALIES. Aa catraucdicftfT wxty iruiy be 
found incimiiTig abnomiulTlfn lA the tuoc, number aod pOiitioa of tht 
lobes, iJ>e gimnicc ad ■oanoiy idbbo of ti»ue. canFlctc ahscnce %4 
the orjcui- id^nonnol mobitfty. and tttti Its diaptocenttirt to Ibe M 

msxASKS or ikb uws— rwvic vwcmn- 



k tctn m compirte nl>tf iwivtsias. It lui been found vithifi 
he Lhanx » caja of dkptiraKnuiic hcmia. nr foIlowtnfE injurT. and 
ttJky be mfttlccdty dupUoad dowawnH. or Kirwved. tvoUcn, aad 
Iikkcsc4 b> tijebt Iauuk, Mulliplc OrpnMJunB i^ it Hitulhu AUft nwy 
|pP«U upc4) iu lUpmor Mtrfftcc, snJ ore not ntulftCtorily tipl^n^di 
the ^\-hW6a tniy br iTTlTTrb bckmg mil rurioui varudamonur 
n the t^K. t^nmhtt and duinbutJon ci iu dvcu^ 

nrFLAMHATlON OF THE tTVBR iaaite Ju^Htu -Ed- 
}loCj. - UilIamiDAii^^ may result djrcal> fn^on bjury or follow mi 
nlriction, <li*tan«t of th« ttovMch u»d iMdilioM w pottxl v^lnt, ^nd 
na^ be tthtt litTiFitr ut 3Up;>ura]JvTr In churKticr 

PYEHIC AB5C£Sb Ot XUK UVER.-lt ^^iii b« rvftdily under \ 
Rood thai pyrmic kIh(o«. vrbober dn^ or. aA it iimaL mulilptc. iiuy 
K*aU from infcolon convcred. directly or Jndirc<i]/H throuj^ aitmaL 
taoUS. or UinphatEc channels- Ariy form of pyemia or j^nenl nrptic 
llwotpLioii may itkiIi in infccljvc toiboliun of the bcijutic Aricty- 1 
i f^mt many of iho suppurative and ulcoratiw teooa of th» abrlom- 
jpjd tnci Rsull m porud rrtibofixni and alxnnai «ny of the ncuie fafec* 
Amu diKftftea In ihclr aevcier foniu may pnxJorc hcfiatic abKCML 
Ikmi^ngn ihe vajii number of UMMiAird coniiiTEnrm may be m^niioned 
nicer and cancer ai the etomaUi and Jamdoiuia. ifd^ammatiun bekI 
BnUgoxt gnowliu InvoifiDg thepoauraa. gall-btaddvoriladijcia, and, 
my okeralirc and suppnmtivc pnioji in uii alioui ihr ititeatina 
lucb ai typhoid fcrer dyienleryp appendkiia, cyatitis. pfoctatitia. 
BUbernilofii. etr. Carin of ihr splnr and abnceiv in and alioui the 
khlnfyi may alto <»ua* bcpalk ab*cc9l> aa may tJ^c «>chinf:c£>ccuai the 
BaFaaiiiiun oolj, asnrirls and livrr flulc». The wi-nU«iS troplcAl impi^ti 
ibMeaa is akawf invariably awodaied with ofavbic dys«nEccy and 
audi an absce« i* oMinorily fr^tary (75%). | 

Symptocos. — Thevc. usually pmnounccd and loraU^iTiK. marc tnrcLy i «i»ib 
latent and obtciitCi MXt thkilyt -unlnry/nu-tii of Iho hopaiic area or {^nnd, 
loraHiM rwHIfn^ pajn, aad Ibe vrHI Liiovm (yinploma of ir^tff. The 
p«iD a nol usually sevnr unLil the ibocca approachca th^ auHacc aA<1 
[» not datkictly kwaUmf, buc fe^l both mvr ibc livvr and in the rr^Vtri 
af the n^i skouldcr blade and in some initancca. (hietly at a point 10 
the left of the nwdian line, bdow the ccatal marjEin, H^afgrmml of 
tfbc iictr U nil irmriahtt tfmpiam nnd irusmJiy ntifM; hcsHc hnih 
||bc npper and krvce hq»|ic bordt^n. should be L^xaminccl unci the o>n 
dhkm of the lower inienpacei lArntigaicd- A li*f^rrrtd mrJling cttr- 
ro^Mcd* to ihc ^pointing" oi the dgcea, ia Invanabi) axo»vc9a3t«4\ 



UEMCAI, DlAGxrttl& 




by «<tcfnA ol the lUpcrtciAl TU&uc«. and in «ojrot iiiMUKta ouyiftov 
flurfujiljctii. AlMMUHtiun m#y Rirml ^iJ^MAif /ri<r»ciiii. due t»ot|«nlM 
involvfmont ^mi prvciMly wmilar !*> pLfurttit^ ffit-tvntfi, ilic IcodoKf 
boing To fnrm adhm'ont atid fimri mmvmrnt. Afl nni^hl lir iofcnrrf 
hjs of firvH^lii a«4 yvixJtt a ma/kct]. dih3 /mj cf apptOSt. mcnin[ 
itwniJiiif. and ta Renero!, ^fi«*tt#«rJ dyspepik phtnomm^, ^'evir ii 
nl^«:r drlLiiiu-ly liLtriniitlcnc i-i dtf iiktlly IrregulAi, ucd U lUB^y aM€> 
ria(«c] frith fhilla. and Kvcrr ri'^lunul «wcAi4. yaB«Ji<« my or ou^ 
nol b« |ipfkrnt Mnd nt kiiT<B sbnuki bt bid upnn lis abimrc. 1; a 
Mid Uial the dcfnibiiua of such » pnlicnl is ctAnctvtisUc; the ri^ 
knee bctn^ dmwn up. the rigbf ihoijdcr Umeml but Ihis m^^t tppl; 
III any diMVAC ntiTntlE)^ \Ka putlcuUx iceioii- Coaiplk«lioD>.--TW 
nnJy fomfitiaimn ncding aricntbn b fitffcfahom^ A tnovt^edft^l Ife 
Himluiniud sltuttuiT- tiiabtra one Ur uikikn^iuiiJ pi h^nv mtiny dirrt^iami 
, iintJ KvfA u-^f jiTtr>«j rcfuJlj. jju hepoHt abu4U may ^urrrw 4mJ da 
tharge ilt retUfuts^ Surh prrfomiLon may otnir outward tkmugfa 
(he ik]Ti^ after the fdTnutiQn of adhcdoru, cfihrr dinctly or, loonf Sn- 
qucDtly, through ■ flauottt burrow. It m^j perforate mto the pkun 
HiiU tauH.- mip^JiiL mid mdtvtJ ma> tuuBC ]?unj1ail jdcurisj m\\k 
diniX pcTfomlioD and nbocrA of the left lobr, or. pfriuntc ihe p^ 
CKtUum, whilt pcnVinUnn intra Ihc pcritonc*! cavity i* ^rry nor. aat It 
thftt iavatvinR tEic porlAl^tin. iht infFrioi vena cavtt And the rifl^ kidney. 
Inwurv Most pnirtiiWcni \\tive mH with fanct of diTCCi perinntiMi njlh 
i;itcr\Tniiie cnipy«a& through tl>c Inro and bn>vchi. The da 
of [Rtt by the brondiui ii lULally ^weeded by »rrnt cough, and' 
cftptctoration of bright md iimtum lad loal exantioitllun vriH iodkalt 
mcrdy a limited oica of (mctimonic infilirmtk^^ Somrtimn it may ht 
that thr Andmgi are r^a\it. rrgntivr. tcz, nhnnly Aftrrn the ^xvt\1 i^ 
In t viiJcni fit of couKhu^. rtutc & cen»iikrabl« quaniliy. oftcntii 
largp imoimi, ot pui^ fMCfmlttd with blood, ofien brown HrrO'fii 
or. bik AUinrdn not infrequently containing ^rvds oE lun^ tiasuc. Siranp 
to mj lU«*€ casfft mny go on for lone; perinds wiili a lUdy eipulsiofi ol 
tjttandticft of pnx, b onr oht rriHincd nvrr a fbE^ am] yet i^nnU' 
ficouMly fultfidc. Ii-a«m){ on>y a colain oinoLint of lower efaMi <lef(innlty 
and crlpplt'il lung h*sf; tb« M of niod«ro turjny !« bowrvtr ahnyi 

Dlfl«r«otiAl Di«giU»«it.^Too of(«n ihvM caia an mittoonrtnictf 
od mliicly overlooked, !^m« ahould l>c Lud upc<ii dw orfifffMe «/ 
^AttiofrM ftuU^s. Furthcnticn. (vA?r;;^rnmf <»/ IA« k^foUe mm $i 
imurioUc. /jiHifd^ vhn prrtcot it. mrrmdjr uggntivr. Mvi iKttt' 


M&tAftES or THE UVCft— ^TVORA. 



«*rf fuvWiifH wfcrthrr o\«f ihc fiw mrljicp of the Mvcr or ibr bwer 
rif^ intcnqiKc ti rowt ikipoit^ai- A MiHt^lij ^fplk Irtnd **f She 
rjmpirmt ai #v fiW^ €lt€€a. Thi tpitm u ntiargtd ^nct thvrv ia 
vuukcd lMCtf(^Aini vrhidi ra&y ujbccccJ 50.000, In cii-.pv^nui. then b 
MatHjr u oBteoedem bbtoiry nggeMinft ihai cotidition mid Uic 
«iilho?^i ri|{n of onQMen] |deiirltlc uudaif (srr fuifi^ 134) shoM 
|icmc TiclpfiilL U JxniM tbc chvtdcr of the t^u* witlulmAn \iy Mptrn- 
tkn. At bttwm iNfitlk aivd tiibclUphnigiiiailc tb«e««M«. n siirg^ml 
ciploEvtion i> oficn nquvtil for pcoitivc diffcicntiAtion. 

ber ol ibvaux. Mid, xhe jirompinFA of dUgnoAb tnH sui^-hI nrUef. 

HEPATIC HYPHR JRMIA-— 'iVinslmi nrtivp hjrrmrmlMRTr im- 
in|Mj^in: Add wc ba^c tu 1.L0 caMDtiAQy widi cAr^nk kypn^im^, which 
it iaririAblt dw tn Aome c«iw tending lo prrrmf the fne flov of binod 
from Uk livrr mio the icsu cavL Amongst tb« Utter qiuci may be 
f&cMiQiDcd dirr^iir heart 1iif»ir^ cspcdnUj inch u itsuJta in dilnlfttion 
of iT>r right hran, luthmn, (^mphirvmji. hmnrhif-naiUii, piilmrmnry 
fibros>0 niid portal Ihrombou*^ Sucb p congestion, typically fthown in 
v^Mts whnv (he trinispid valve but ^vtn wij. rrsults in the produttion 
of the K-called outmcg liver, hcK bcms ccnird lobular canRcslbn 
with pcftph«nl aiunnia uvoiitted witft fntij defeneration, IV 
Itrcr Is Urjff. thj>it);h in ihc pmvncf (if Ion); (DntlnLinl ciin|^ij<in it 
nay ^inktip) ■ certain Bmoiiat oj coniniction uttcfukd by lU* tamta- 
tkm nf 4 finHj nrxfukr niifjicv, and »rrtion itinwt tUrk nd marklnpi 
OD a light backKTovadj from whence anxs chc ninie "culmrj; livti/' 

SfllJpBOUM- — Tbc ettTfilttl lymptom is vft^nJff »■ li^ u rKOf^i/e-d 
by paipal^Q ar itcrL'uwkm, ^ilb ctpritLd icftn-ncc !o ttir Wtr Uirdcr. 
or lackkqc thli, incnavd d«ii&lty iia»4:kloil wiLh t certain unount of 
fvosMt* trvtdrmrn panlnibri^ «Tvcf il:f kft li>l>e. l};v uvnnfUry ]i}Tnp- 
loins (VKh aa chronic gnatric cauirHi tad inlettinal disturbanct-}, and 
the uiUMite of a primal^ ciute. AtdE«4 mij or way not h^ prwnt. 
RCCDidlAK ^^ '^o dc|t^e« of f hangc prodiLccd and hxnmlcmisii is ran. 

TOMORS OF THE LIVER, -t'linmiy miUnnani disoAse of the 
livrr whether BucviiiHtuua 01 taftinouiaiouH '& rxtcSMtcly ftie- Sec- 
oEtdary arcifiomatciu tcirtwih* nft comm^in. Mrcoma moM unuiuaL 

SecOffUlafy CarclnoilUI.^McM oUi-i\ folIoWH Envohrmrnl of ibf 
■toniKk. paaocui %idnqr and iaicstki<»p and usually nrsl uppcan in 
ih« rinhi kibfc As the proccst adrmeei* the nodubr muss n^6 to 
sofM Bftd kcccnDG unbflkakd Iijp (t-Dinl altfuTption, \^ wn&'^hiA 











Point! dI 


bcbf oflcfltfaMS 4btinclJr palpable CyMlc TluDon tat ntt. aad 
usually Mial]. Thty ordinajLly origiiuif in th« g*U diKts* and jMd 
a dear or slightly yelknr fluid. 

PARASITIC inVOLVBHENT. Tbc t^ma^^ coli U tbe ciuue ol 
piaciicflUy nit Iropkal ahvnua^ ^i^^g round KmnelimeK, etm m thv 
absence of dyvmicric syfoptomfl^ The cchtaocoecot b the moA kft* < 
poitanc oi Tfif I'jirtiiijt iilFuT fr^rmi sf paruiin rarounicnrL 

BCQINOCOCCUS CYSTS.— Thc»: orr <iac to tbt cfnbqv 
of liif ttKah echrnococais. a u^ worm, which u nuvfy eikcoun- 
Ccnd vavc m IirlAnd nrtl AuunLk, tliougb fouibd oocaafaMuDj 
in Germany, and now an<J iben met with amoApllbc Icdamkei 
vhn hnvt wt^M in Hrttlah Gotttmbia. Th« wctftn b ocit mnrr 
than a quarter of an inch in Icneth. i&d bch>ii]E» finpcriy to Uk 
dog. If u rompos«d of three or four 9fffxv^tls, 
tbc malure IcnnJiuil poxiion bdnjf about muiL. 
long arid Q.t> mm. wide, yet it cuDlaina Gcvcrt] 
ihrutAui! rxK» The tmd fihowa a ruAtt-Uurn 
4 suckcri and j ruw» of bookleb; the ombryc 
provided witli nx hoak« acd arraaged io 
paiiii, mokes tia way diHiuifh the tntc»llnal miQ 
and may caitr Ifae poriitl vc«*tl and be cavriad 
^m Lhe |j\er and Eire ^aiemic mmmIb by 
which it rfaduv tbo bnin or otber distant 
organik or il may remafrt in thr^ prritonoaJ 
cniicy or tbc lurroundkg nnudcs. Il ia 
thought that thia embryo tnay tnd entrance 
thjxtkiKh iii(cc(?d duBt ua well as l}jiuu^ 
dhftkiri^ Walter and in AiutraJia and Inland itbpfv Eh* dkeaae 
prrt^irnt. the <lngi uir vrry gcnrndly inlrriH] aod [he rvlatioci br rwim 
tbem and their moatcra b very dom. 

General Symploma of Hjrdaitda.— DfagMSU prlmanly dapvoda 
upon Ifae procncc of a cystic tumur and upon the rccemry of Iraokkta 
from fluids diichargad or obtainv*! by puncture. Tha praaenoe oC 
hydatid i^onoe in other ponron.i of ibc body u of conat fotgget' 
tire. In the liver* the tynptoros are more dulinci. nwing to the tact 
ihat thrv eym Khen auperfidal Ktre ujtcm parruttdMi a pKtUfar 
vibmcion known m the "hydatid** tbtUL Sec page a.p. TLev nur 
be tarK?, anrl. in thitt joratlon* produce varioui pnaauie lyniFit^nu* 
or pymiic lyitiptGnii alioidd Ibey aupparate- Sudi cysU like hepaikc 
ab«e<aMa may ivpltire in aJnioei cmy direction. 

Fit, MK— TiKtiA 

D«£EASia or Tflx uvn— cputeoscsy 



C1RRH06IS OF THS UVEIL-Tbe «ntnl fwtor b >1I 
fonns of cirrboib of (hr Irvrr tf iht iocruat of roittieclivrr 
tame. And die tenn b a j^tufral one. applied to licuUr cban^^ 
in oikcv orpHV^ W« bnvr ^Mniailf to dr^il trith four nn- 
etks. <i«t). Lauuiec'k cirrboiiA; iht common foim ol the 
dlMtt» aa <n<ountcTed In ttcry dinic [and). Hftnot's cirr- 1 
bo«lA (jrd), ^rpUlltU cirrtioKi*. Uih>, ChronLc pcrihopailtlsor | 
cvpsubr dnfioaia. Th« drrboin due totbronicdiKAAcof the heurt <a < 
iu&p. (nntmpg livn). ii (IucukrI iinHrr chrome hj|itnrmiA. and Inrgr j^ .Viii<mpc 
nianbcn of mltuvr foniw of »inc pAliiobgic and «tiolckgic intcrvat I 
Mad Mil b« disciucied in Uui whisDc^ Etiology, — Ccruic of ih« inf«c- , 
tioatt boll) acuCT uid dinmic may iv«uJt in tlirliEilIc ch&^^cv- Cinvnk Umr 
otMtruiCtiaa of ibe bdt ducu, chronk pa«lva hjrptrmia and aathfacoaia *^ 
nrvtohe numb^rrd amunj^ the vtiuToj^fc tatton. AlniboJ U thp one 
naSr imponAUt eaioc of Laetxnec's tirrhosiv the form of prtdominani 
Intoetf nfid frpqumnr of oemmncv, and informiuion enntrrning ibe 
cxbcal and duntion of aloaholjc indul^eiicc u prercriucijicio dUfno^. 
Govt, Lead pOLBsninf* and th« «s««»lv« conaumption of higlily vpic«d 
nnd over-iidi aitidca uf food, though uonUthtiLive Eutdn- lueA^ldicini 
of prkaaiy inportsnce- ll loUovs then that laclcinR a history of pro- 
longed uenf aleifAmlapcsitivrilufi^oAiiof Ijimncr'neirrhiuiiiwi]] ofim 
prove emocouf, vbilc on the other hartd, a knowkdjcc f>f previous aJco- 
Itolic inital^met, men ihou^mockraia, may augfiratlhr proper ftpUn- 
■tion for manr «tMCUR ffalro-lnicatiiia] armptonu. HoiUd Anal- 
omXf t^Tm* atraf/iif fvrr^<>m, or ^'gin dnnkert^ liva" \t unafl, hard, 
ndjtang to ihc knife, uiJ Inrgularly hbulatcil at inidiikr. The Utile 
nodwk* snay. br the ciHiEmction of the fibToufl honchi, l>co:irDr promi 
iwfir^ SAd thuH fnmi ihc "liobnan lircr/' » c^frrl fmm Iik mrrnhlnnfrc 
to tfaa hobaail shoe. Tlw color J* ^dkiv. and ihc cut ^tjditte » nn^tilcd 
wttb cokr running from y«IJvv: to bvewn. MScmscopicatly, tb* chao^ 
coiMt in the fiormalna oi new coancdivc li^ue around cJie ahealh 
ol Ite nn, and Ihu. contmctiDg, causn oompRsaion of tJie p«itat 
mpfllute parlfl] nhfirurtinn, and, chrrrforp, con^nXian ol :ill ihc Letn< 
tOT nonulfy drninci by the portal vctn. /J ii '^ij ^hranii /cuir^ 
CffH^/iiiurt irJbfA prtntnoj mosf r>) thu cUi^at tympUnm of Ikj tUft^sf. 
autb aa aadlca. dirtmic ca^arrlial ^patrills. cntinlia. hKuutcmtwo. bleed- 
ing hcHkorrfaoidt, and. Uial i^iiM^^Mk i>f Ihv iup«ifidal abdonhial vain* 
ksovfi ■8tbeCBptitMeduur-chUluli>mptuii]Af>):«arin|t, usually, if at | 
all, ftJW the onooming of udtu, nhrcb is a direct and importaai | 
ctcitribiilnfly £wtfir. Hypertrophic CitthoUa.— Colleid %\iA\ic:^\!n^-\ 


" Hobuil 

Siftofcf <if 






til noil 

enow and biluuy. it b a tcmpftrkdrcly nrt form. >n<l k chuvicr' 
I/C(l by ft xcnrimJ Incnwc In mzc anil la finu muflAixie U> jtcct^ 
th*n if |tn««nE jn Ihc lUrophic fckrnL Ualh Ihc 4cil«r adiI the col stf- 
U(ir« Arr cnmfmrHihT-Ijr 4mf>i>ili inri ih^ irtm unnohuUr >3 oppc w l lo 
mdiilobular 14 appJicd to thiB condition* because <4 the iavolntiiiaa *l 
imth-iduaJ Kiffl raih^ thin of gTou|tt^ The pMCVB li pnaicallj & 
t>cr^diolu]Ki(ui ukd there u much cridcndc to ivpporl tht cbcix^ ti 
iifcct tnfcdkvi m the pnnuiry cntue, WrUi«pAtitift ov Cap wito 
Ckr hosts. - -Thk U oiirrtly a cliiordc optuliEK tLcliwTMi 
t&king Utile or no part m tbo pa«c«eB. Tbff aune ^foccaa in the 
and [irrilfiniriim i« ukl ti> bv an almott mrarfHlilr Mmcnparlmenu 
k chronk ktlfrttiiia] ncphtitu. Cblcr dcKfibca two tljuiea of cHch 
oiv Msodatcd with liic ordmiuy Lvniplomt ol drrhovk the ulhct- wib 
•ijlirrmi ^irikHrEiim and duodc focdfasliaitk 

Symptonifl of L4iaaotc^ CinlMiii.~A dtafpous ai ibe oHiaur 
rum of rirrhri^U of Ihr Ihrr ilcprntLi urdinariir Bo an unvraal dppcc 
ufnn the ki^owinlRT of the palltct'* babJu D.nd Ihc fffopc-riot 
of »econ Jary lymptOKOL Grvn any t^tf prur^ting a kiiUty 9j 
Mtk Iff irm mvdtnit atn^MU MmlxaHc tt.lendi'te rtucr pmaS 
i>f m^my wcTf mid Huwing tymfhmt 0} (kfHtit g4tiri< <«lapfj^ 
thrrmk catonkat aiUnSu,fVfK ^itkcnl tumBfrktidi *md kttmM^tmait^ 
Ihr Hiafcnosij e/ «n tJriainf kr^lit iirrkffsij skoM tdw»yt frtuni 
iheif Tlte diirair h itidtm riir^sniud untlT nvil 9^9mtffii. bM iku 
i> w dtruttt dttt in rtifijty imiltaKtj to /otiarr tc apfntMe At vidav 
^i ^utfflf diagntttk ffuiatt. Th« phytiraJ tlgn« nf ihe dbtaae maf 
or may not be well defined. By auxultalcvy anil dirri-i pvTVUMion amt 
by palpation one CLay usually mmkc out a dvddcd rfvnUitnit in tlae 
hc!pulc nutlioe. a4vl. ciprrjaL Mn»» should be laid upan the ia^ ihat ilir 
AiWy itmnk^g^e it mtut iruirM ntr the lf[l hhe. The rplttm ij 
meditatfty tniarsnt in 75 <tr Ko% "^ '^^ nun, another facuir uf jp«M 
[mportaacc- Tic •O'callcd prcaUx^hic staiec of ciiKvr^iccneat la va 
Mbfotn poaitiTtLy d«trnma^S Ihil it might la wvLl b« diftoanM M 
unpnwcn- Anolhu folkqr Is lIlai fvtiunbs 10 the diiva leoinpilite 
by palpatbn d tht hobnail projcclion-n on the hvtr turiacc. 'Fhcw 
fan nudy be fck. arri rto tnvm i^ulrl br IntH upon arfpitlvr- Andia^ 
ITAm fh« Jtocr ten U ^p^»<4. ih4 tk4rf jUm tdgt hMmfrng 
imdut^Utm is m»rl rrnggfttt^r imd t^miblr. A co-»xiaieikt aadica 
ordinarily niakc« it imponi^lt to accuialdy palpate tbha the Hvcf «f 
tpltm and in Euiy cucb caio the bot oppoftusuty tthna imtn 
aflcrthca^dntionDdlhcaadlicaukl. Tlic KXallcd "digipfaig'* 

MBKASse ct tax ijvsn— cuRoosD, 


to attta nromnendtd, which rtinxlttA fa* butyirifr ihc ftniEtnt hy a sharp ' 
rtnbc upon ihe abilMain*) vrdl in onUr lo dL»i>ia(c Uic fluiil JincI mvcl | 
(Iv itMcnirlirii^ liwr nfgi' in m>i|]in[>itri in utuiLtly fulilr Thr t*t\pui- 
Mtdmv. 90 talk*! from its fondfuJ rcscmbUftcc to ihc Mc^us lurai is 
kmnedbjthepnljugmprilof ttifftufffrfid^bilCTBltviniof ihc Etbdomrn, 
And wlitii (■'CKiil i> A hymptam of moch micrcsl ftinJ mii'^rULDtc. . 
Gvdj difiiriBn miut mliEc howciYr, Ihat I'l M « AMi^jfrw ratity^ I 
iDONOVcr. it Es tttltn conftiuiickd w{ih the t^rral rlWcnsiciTi ttt lh«;| 
iiiipMifHilt «l»iiacninal vrina md villi in v&rious coDclitiona frodudn^i 
pmmir and ohsimiinn in ihir abdnminal cirruU. It ^hnulc! hn k<^pi 
bf il>c1f u A dcuty ddbitxl s^plom, i» ihc reins nhjch rcprocnL the 
SdcdiBA lodci Afc the Ut«Tal veins jotninj; the «xiLhiry tnd the fctnora). : 
and pottett • cudooi vvlrvUr oninici^ii^crLl, nk^ich nomitdly ilI(Ti:i»i 
blood A«w Itom Above the umhiJicvii lo ihc axilLa. Ami bdaw IL U> Lh? ' 
fennnl vrhu. hut. ki the pn-^no: of ttf\y mArkcd otttiruuirnt, [irrrnit a ' 
duiecl vpmH ffow. To eiimmArur ; - Ihc dkgno^ of alrophic drrhosJa 
mill rwl apun •orne ur »]I ihf faiiowing dAU?— <a>, A history o} high 
MviMgu mftr-fndinf. iiW »'■ ncartj evfry tnttatue akokvlU indiJ^tncr, 

£jx43$tvt ftwmtmtainm. utitlipaiirm <n iitkrmititnt diiirrhtra^ aitdl 
vthMtS olMtr symptoms 9J thrtrtU juim or inttxfimi laiarrh. (c). 
Th* mvfiiifPM e/ d tkntukm. tutfdfmt d Srtvr and mtargid sfitm, 
(d). Loa of vriikl, iJnrit^A. a^ivity >tnd crUr (a ruddy fttUt may 
penitf u&lU lifr in (Iv dufav), (n^ UmnrrkMr, Mhd at bWdin);. 
ff>. Aidlu. i]/i). Hitm^krae$ii, i)t\ J^amiiift- Thh laal is an uii- 
vsaI p^ptoiii in aitophfe drrhoAut. thou^ tomKLinira m^ with during 
ilie hut mnmhs in a farm so vxtivmt as Iv pfoduc* a tolor strikmgly 
tike that seca in *^dd£s<Mi'A tfiaeaaa it ntiui nei«r br forf^Ccn ihhi 
thf auiift */ iifl^fhif tirrkoHi fir^inarUy prttrrtfi any maited f^mrrtil 
^dtr^iA i)r«iidJarA] And rctnAJn^ iuuaUj for a kmx pcric>d qjit(^ Almtt or 
WioriAlMl with A mcKlcriie fvlftnA nf the Inwcr ertremiiiffr diir ia 
pnBSttur cjulcd by (he Aadtic iuid. Thnt gvica fumiah Aomc typicAl 
en»pleA oi the " pMched f^ bdty. " 

PrafDOsb.— Tbf dneAv Utinwiy pm^rmivr and fK^nod |}im^*u- 
lk> thovg^ the ceMAtMn of the uae of Alcohol, or of Any other htbilft 
of A ilnnAf BAtttfe; ATid I Uinmu|^1y hygfenic lifi^ vill do much 10 ' 
Icngihcn liic i^tUnt'i Icnn, 

DiSvrtOtiAl DiiCtMfllfl. "5^^^ atfiri>^Ay aj lA/ /fur. ThiacoH-l 
dltioa AtoonuMMB vatwui isthciiAH, chAmctcrucd hj pn?found ojuiwd' ; 
tloa AfidaMnsinUiHMgB»tedbyM)diooQdilions.»^ ^kia«?u&'u^ 







OlitO tHA, 





interat or impoTlAncr- jVvJmff lih«r An airopSk minneg 

muy pvc riac to much dilficullT, bur ihc pitcixiiaicr of itiiniT of ttb 

tung ar heart, uid itw lict ihtt ti doM not ptnmt & pvtnuuj ucto. 

htii ctnp MTnni^iy u> A j^ncrzl ^iixsinx luuallf suOicn Ibr it* difirr 

cntialion^ F-iUy cirrhotii Hvrr A vcr^' coooidfnbk noiaAier of tbc 

CMMOf drrtifMi* thu vp mu^ whti %tp fatty Wvent. a f n«m rstdy ftit> 

J ogiind b7 pvJptttioiu the orcui bdn^ okcvxlfcikilof firm cottiiwtatt' 

h jiiiwinu oo iM<ntkl difffrtnM in i^ptom&icilogr from that ai tiM 

ordinATX atro|>hic fbnu. FtrttiJ fhlfhitis andthrffmbtrrif^ The 

<if thin conidiiioa depends ctuefi^ upon Ihe eviAtc^iuc c4 ft poMfit 

■nch AH Dkvmlon. gnff uanr vtd %U]ipnnxivtt ^hmtiatn^ psrrmll^ At 

coDtlhioo b fiiACC4lccl by a very ra^^ tmsti ff}^nSrt, st>kaSc mUnrc< 

tnmi, jLnrl thr nibirr i^rmproiTMof pon^l itWrjcifnn. lo y ihcr «iih ihrlr 

ra^id rtotirrtncc &flrr p&raccnlc^ tJiou^ this ymnednMS occim b 

mic drrhooi- The «p«dQc s'^^iiy oi the titar oidik fluid is nenlr 

«hrR^ bchiH 1015 b the cue of drrboshk irhejiAA, bi chnmk pot- 

t<mili« kl u dtiUnctly turbid, and in ovAriin cytA, of hf^licr ip>d6e 

gmvhy uul rontnlnfnj^ a gmitrr nmrnifit nf kThnntti Hypnthrofle 

GnbOAiA rVtanot'a diKutf, bilrftfY cErrho^u^y— Thb b a cofafNt- 

aiivdy rvrc ailment, and can hardly be ccniounded with tne dnfe»* 

sb- itic ifikcn la cnbrgcd, ktcnn b bicmc u4 llic «coanduy 

sympiofti* of portal obMniction ar« tnClfd^ afcacnl aadiM ff octxuttag 

ai all, roming on Urr as a pan of ibe gRwral cafbnda. The cofal 

of the stoot abovra an inlCTrnittml Uk seoirtioo, the urne it 

u conifiaTi^ with thai of arrophk drrhonR, and rontataa 

Tbc dlacuc b cnc of Lons dufadon. U«cIti( on |}ie avcnc* from Ak 

t6 Ian v«a». Sypliilitic Cirriiofiia.— l hia dbcaar may aaniDM aMbar 

ail atntpLiL ui hypenropbic lypc and rtpnacsia a smuinc inlaivlllBl 

■j'phiblic bttpatJIb. Ai tMn iri ihf nHult it b aliephk. in childnn. 

oMinnr^y hjpcrtnifihfc. A ]jraiiivr dugnodi it ncttr povdht^. b«t b 

fvnilcnd ptobabk br the hbtory ov matiod ovldcftcc of aypliDk 

SyphlUtic Gtunmsta of tbe Liver. — ThvaMnayoctfcrai flf)jap^,tf a 

ic»uh cithn i>f ixinjtcnilal or a<iiuitTd a^hilia. and, varying frraOl} ai 

, tiar, 'I'bc dirical plctur* w ihxt <-1 bfpatic drrhotb. bvt afler tbc 

removal oi any utlik duiil thai aLiy be prcim:. ibc nodular flutlioc 

of the Uv*r b otten appredabk- Certain ttMt diow a p«cular laMBcy 

] na ivgarda gms^iJ aynptiMT». though RpmcMlng maitod aod 

noo^iiaabk tttattyr. Tk4 mfit m^Of«onf tHtri^ Ai^/cwNtf ii Acf 

«Mf aMU W«ft a iMhteior r^MT, wM dr wilhata tjtwfhmt 0] 

The coia 



jccd ktatmmi, and indttd ihh $hoM be opplud in firm^tio^ly 
ttU MM* #/ Md grvttlks in 0i4 abSflndntl rffUm. AmyloU 
LiffC (un^fcid decgencndujn cf the tivtr^-'Thb condttion m 
tfiTukblj aecooduy to »itic tesm dcranf^cmcnl ol SMttboUnPi 
ofitdAlIf thofr. ttsnHAtcd *rt!h rhronSr jpplk nb-'crptiot], ^ riri™ 
^ boiko tfd pulmofttfy lubcrculostf of the ad^nMC'] tyi>c. Il 
vsf (bo bt ibe ftcult of ffcfonk and iirgl«<trd «yydilHr1c Intoctkn, 
The Liixr a U7^> smoottL. uiU ^ syiii(>tonid vf idia\ ubotractkHi 
m absfal, ld«rus It seldom prnfoC. The iluwur ii int^irubty 
£ftLkl. I 

CATARRHAL JAUNDICE {ac^ cciank &} Hu hUc dmai).— 
Thhi k Cfltmiidty s ptrr eti a mnrrhfLC f^Tn^-dLiorlpn^ftt and U nflti- 
■Sy an cbviiiiclivc i&undicr, tltx to inflammatory produd^ ami jrwcllinx- 
It U MpMkllf <t»inakqQ in cHHr^ii but m%y W rnec tu^h st all agn in 
QwncoioD vilh *cu» or 9ul«cute indigcrinn ot a JjirEr nunjiKt <jf 
<di«Mei MgQciitcd vitb ft tctiftpncy 10 catarHitJ infixmirintion of the 
npprr InlnuruJ liBCf- It foonctlma ncctiu Io be qiidonlc and due to 
Mutc Iftf«ction. SiTt for ibc evidence of jAuodlce {color, ti^^bt 
pMlf flieofa;. «<J if maj* ht whnlijr «ymfitnm1rtt. or specially 
in the epidemic intin. thcrt are ^Trnptotna of in^igcsticp aoMckted 
with nild fever smd gmeml mahise. Tbr lirrr it utuolly iEghUy 
cftlar^ bui the *iiloen rarely lumdto, Dunitiom a fnun 9 to t? 
wccki, CAnvttf ^^loitAai jaumdkt i« merely an <-i|iTfS3]'on cf rbronle 
oMtruttioci, <Iue to any of ihr lauan ilnrriLnl on thp preredinK 
pi^ It may be ocvnpleit cv incompktt. |)cnL-lfnt or inlftmiUcnU 
and vrill be dkciuied t^jrlkei binder diotnyiiitii and rbolplitliiuit. 

ACUTE CnOLECVSTlTIS.— In from 15 to id^ of the cmct a 
efeolecTviicU «xUU vithetd gsiJl iriofiea oralhcreauul MiciLlonA- The 
flon of the dbruc tndudr a pyogenic iNAL^^yl"^^^^ "^ Hrn>ior»cc.u». 
paeaancotxuu coJon and typhoid barillin. 

SyiUptURIi* — Ft idhwld be tfaled emphafiinry Ihal f/iundi€e may 
&f may nai bt praad and that the ^I'lt mo> be distin^y Iccoiitcd 
in fkt fffMM ffj Ikf tif #y Me ^ <o$tti *ertihit. ovrr tkt gail-hUfid^ 
iUdf^ «r, amy frd bt rrf^rrrd h Me *p*tiukimm vr twtn tht rf^ivn vt 
tk4 appmdif. FaaD U olao feJt umuLly under the right scapula or 
eren tn thr right «hauliler. TVrr are nanen. VEirnitTrf;, nipd pjlsr, 
itvcT, prodtraxioa local tendemes and r];>idity whiVh in tnoal tmtn 
beeoime defnlteh- localiied, 

CnOLELlTRlASlS.— OftU Xonca mny be ilnidc or praeni bythe 
^WHtredorlhoiMUtdlutuallyfnim J^ioor 19 arc rati withV Thc^TccKS 






ucDKAL MACiroca. 





IL ^''^ 


iMjy ia 1^ from mere gnun« Xo ^tooet HMMuring (ix india or 

twznd. T^i-jr have » ducIiuu, uwalty oi bile pipncnl t&d 
hive hwn ivponrd infl tmrfoubtrrHir a^rr An\vr]y citatrnv^t \A 
I proccoan kadipg to thdr fomxAllo». Sccbon ahowj Luiunatcd scau' 
lurct vrtUi nidiBCtoiu uid ui Aiulys* nwali biliary ind fiUjr addc 
rTia£iic»iacn and cakhan ulb and tvcn Irn^cs of iroQ uid oop^c 
Ch<»le»tchn <cr*lituiC9 the bulk nf the tlooc. ihdr color U brawn Aal 
ihr BiirrAcrr iimy br Tvugh tnd niulberry iJVv^ AvIopslM Uiow an 
utonUhin^y htf^ nuinLcT oT OUCtt of ^1 Mcota* md hvrv piwoi 
jhif during lifr thry have in minjr iiuunca yitkterl no ijTiipuiim wi« 
^iifbAtjIy "indigiitiim." "fUtukncc" aad Lhc Hke. Orduurily Uku- 
migratkm fnla llic ducta ^|his» ri*c to bitiuy coUc. TbU u chu«(t«r- 
JxnJ by riotrri and abrupt pitm in fA« r»f /h' kypH^irrnlriat rtgitm «r 

tinuttilary drpttttum and utiuiily interrmJImt fmrr wMifk may ht ptt^ 
irdfd by J ik<irp cktii. The looklucd ktkttfruts ind muscoUr figi^tf 
imd flfirr a lime lo fr«£aav hteakaed in Itu region olthfHp^Jtiu miiilh 
uTJiOii lortU^gty tbc liver uiil apletsi itiay be cnlaiiettl. a;iJ tiic uivc 
fra^iicatly TOctaiiiB albumin. If the slonc br in tlitr cy^ic Juct tkeiP 
U nn jflundfcF, nrbm a fuggrslioa of It jniUracing L^mplitatingchnlw- 
Iptlj; in Lhr common Huct, pcrmdcnt and »o<crT cbstruaivc, or, tbiihl 
lfan«Irni Jaundin-.t Tbne altu-ki may b« RfvafMl until (At alone 
panca oiiward or bxck^arl ur is removed by optrtllon, aad daith 
juvly occurring dunn^ ur ntladc. though |>hIeg|nonp nipiur* and gCD' 
«ral pmtnnilb arr pontbic;. The liK^tiiui of rhe pain in Ihi; ufip^ 
abdominal o^nd lower thoracic »cf^cnt wilii locoiscd kndtmcn* [litfl 
^Udird by dcrp pmuiin; Ir full hftyilrallon} and prrha|v a hfanwy of 
prvWou* atlocka ait the chief dltf ic^iahinjE aym^ms. If Janndkc 
ci>-MCi» th« diagniMk ii aloiocl abMluk* ycrt Lhr aulhor baa rfporicd « 
cue, of flottias kidiicyp auutlittcd wiih Dictrs critcs durinjt vrbich 
JBundkc occurred and opcralion trrcakd a nornul gaU -bladder. A 
Mnnnd atx <if fkinlmjE kJdnry In whiiii the aajnc condilJon nrhhant 
jaundice exUCed anci p'^vfuj lo U- due to k*^ alone*. A ca*c moR 
fvcmily obwrvrd thnwril no irnclrrmi'M rttrr ihi^ livn or gall-blaridrr 

*Auiop^f9 abif ddn'miimie the itulfnir ^ iv3c>><taMd dioltliiUaab 10 
IcaJ ti) tnrtinmru i>f ilic KAtl-UjKliIrr -ihc Utur dwuc boat acUoia 
found i*ilh<nil (he foimci— but this ika not apply lo oprratfd r^Tn 

tUanf •loaca an «f die "ball va^" *>riely, |>rvbtrai obfirKlioa 
Bot baing maiotaiocd 

i>tdMfic^ or TUE cuu£-iifju>oc]t— otOLBnmnta. 




rrtD unilcr fordblc ilrtp upvant pfrfMrr hi tltry ita\i\n\:im and \ht 
paki tt«A imrirubly fr^ fiiM. The stools ahoujd bi? curcruLly cmoincil 
donnf axl imnifdiai«'Jy aftrr jl iupfnK<] i:tick. GaII ilono, chol^ 
CTBtitiior adboiaos nuy jdiXc ^fc rue to recurrent Attnck-tof more en' 
Iftt ficvtfe f«ie tnd ^ old j^iilro-diuHltnal ulcer may throunS Ibe 
MUX ttuar bcuaucuilcO witti «yni|JUiiiu liiirtlij lUMiiLKuibl^dblc Jfum; 

Obalnicllon of ih9 CocunoD Duel. — ObsiruriiDn ma/ br al^wv 
luir with profoiin<l and pcrwintt jiundice (pale Mool). r4c,} Mid br ^viit 
rtne li> otic or wwnl ttnnni, nr ft may bt only ftiitbl wiih mnittt-nt 
JAUodicr or n w^alU b&U raJic ttvnc jPivtlutmic ]iaro>>^mA] tbilJ:i u«u ^tivc 
vrith 6rfier anri cvrvatiag:. pviaiiUm buE vtriibl* jaun<iioc, tnieiuii£td 
dona^ Uic poiwiyim. bqvLlk |Kiin anii [iidiifoliuu, Su|)|>unvliuii 
BMj or may Dot oamplkj-e ccciTnoa ii%i<t stents and empyema of 
(he pUl'fala.dder aftd evm hrpotk almru or piffomtion miU'otcur 
Ml vrookf be iddktfcd by a more pcnblcnl fn^vr. Kmllteni raihcr than 
^^mkUfiU nvirr mvtr^ cabirgtcnriti at the Itver and IriMocytodik 

Cy«tlc Duct.— Tlu^ dikf Utatunscrf c>vUi: obnnidiun vr Ihc a^cnf 
^ iii^kJ ^Mnduf . ihc di£(«ri9Mn of the gall bliuJdcr. wfaidb may rt^^h 
An enonooua aat aivl. the rommon of mrrrncr of a ncimpllQUing dio1c> 
cytliU* ocfAMOOalSy ol titc »«pfMrattrc IffiC wlib ciupycnia r>f tbc i^iQ- 
hladckr. CAtdilnLtl<in of rhr walU and »tn>pSy may nccMr thnunh Uw ArroErt>'^ 
(rariianilf tkas in common tlcirl slonn, la lome n»» is M complete 
a« lo k*«i» harder a Incr upua lupor^dal ManiinatLon, M in & caw 
knn by die auihor in Mhkh n nrrftJ ilivTL-cioi] w-aa irr^uire^ a;ii1 
repealed tht pmente cl a hrjce number ol tb^ries apparently embedded 
in tht htfuk tbmt, Vnrt U Irw nfim ^imrfit than in Ame oF tbc 
coaunun dtict 

Gaund C«iiim#nt.— r^^ H«nu;f 'ii^<tUty may bf ttpvifiterd Im i oima 
60fA MCKir mJ dtnmk /anas (>/ «Ai>U^iasi <v thoUtytlitii anil Ibf '^*'^ 
gmMi Upev Eauft be laid upon the lomtioa 0I lii« pain in<9 prrccncr j'«in >^ 
of ItmUecd iciuleiTseM, hfttpenlve of Jaundice whkh of tiounr greatly 
aantta the dia|t&o«i» mhtn imartkL A pdpablc gall btuddc-r oiovttt 
vkh retfifaaiktt. haa Ua polni of «rtarhinr-nt En ihe rejckvi ^if the ninth 
ccvUl cviQai^ Bsd b axivabk ooly b tbc ^ETncnl of a circle whose 
ctonn b ita aitaduDcni. ll dioald b« notH thai jiundSc^ of muhefl 
degree » abacnt m obsuuclaoo of llie cyclic: duct and a dlfitrndctl^all- 
bUddo- B me in ottflncthMi of Uie ccttnmaa duct. Stone in l)i« coni> 
mcin ilua U mttuUy anoclaivd wflh a cmrtRwioI i^Uaddet; In tbc 
cyAic duct wtlb diiacottkin ; in Duljgnaal djsca«c blocktiyjt ^^ oanvvvxt ' 






urmcAL DU€3«0aS, 




dua -nhh dlslendi>n,* profound Miid penisfioM jivndjoc. digbl or 
pain, f-'intjUy: - AW dtfcno df paU, fmr and fe/td^nesi auy be 

ACUTE VELLOW ATROPHY, (/^"i-i Xrittiif. yaKgn^wi 

Etiology.— T)iu cxtruivcly r>rt diacjutc cbk^ ^Hbos women mtA 
UIU inc«dy upc<n the thinl decade, ll u inquendy fLModatod 
pregnancy, fais fnllnw^i pnifintnd emotion ox shodti ^pliilia, 
nceae ajid vaiious oihcr ill-deiermfnc*! fjidon. 

MorMd Acalomy.— Thf liver [Tilt »rr nrrmclr* &nd there fs ■ gcfi- 
era.1 C4tntth of ibc (incr bile ducts AModalcd with bcmorrhagu betnvco 
[he livct oeU>. Tb« CTgan itsdf t« gwrrnish yrtloir, ^*tly ihn:nh«B, 
flabby, with «l Uxm afauic. nnd on KciJaQ it u mrAtlci with }^krwtib 
brtMvo »nd rod. 'J1ie hcvt mny «how fatly degcnenuiao. the itpk«n b 
i»ufiJty <-ntHr^ and the blilnry^ rnay af«o >k- di-|!rnmiEr(l- SyBt|h- 
tonk>,— The picttirv i» prirnnrily Ihjtt of • Cftt srrfi a) jaundice aucttokd 
rn t frv Ap,y% or perdnpa two nr Ihnw wrrk!! by vunuliiig, 
bloody »ubai1»n«ou» and tnucout hcmonbaj^, hcadjidie. 
moKle ininor and tomctimM convuUioni, The jaundice deoprai «ttb 
Lbc ouTict of llic ^VTC symjilums. Thrrt h uaually uo fcitr. rvdy ■ 
niArti?il pymda. 'Fh^ ^neral conJili^n iti Ihut of lh« typboid sBftte 
and ihr ci^fllrinn i^rmintiM cnlinarily m coma. Shrinbagr ol llie 
liver may jcciuly rT:ducc or miircly otJIieriie it» norrQiil 4LRfi d 4u!^ 
ntm. Th« udni* <n(iulnK hD^ ftvqufntly alhumin. albufnowandtatfAi 
Leatin and tymin art frct|ticmly bui not constantly prehear, tbr atoob 
ani (Uy rolorrd, urra it dInlinlAheil but ittni^tiia nilroijvn ia incrtayt^ 

DifTeiealia] DUfnods. — The iniensUng sjinptum ^>up dilla* 
eniicLt» this diKAsc from all otbera noept phofphonuf pcbanirtjt fo 
vhkh the thfpe leitilln^ nytnpiomK. tit '. — hifmorThoge. profoimrl Jaundlcr 
andahrinkafECofllK liver may ocrtjr. The examination of lise vooiiiv. 
and btiiory of Iba cut arr thr rhicf di^iinguiahln; potnia Gavv 
vymptoaa may occur id connection with otbrr di»eaaea nsodalicd wMi 
jaondkv but Ihe picfure of acute atrophv is cctdom pnWiC 

WEIL'S DISEASE iaciM /rfri?//j«rt*«).-Tbfa(Hsftut U w*h 

*Tfc« linguiform pincEaa of |ttcd«] AJid Crvri-illwr (Ritdct'a laht) b 
tatceuUy cmnmon io ehraaie dliiatc uf ihc ijiUbUddrr, li^uxh oce —k m^ 
(j'y prt4rtil m olhfr ibdrxniiu] ailrnvnA (MntT^ihAn]- It nuy llr to t^iilhtv 
tide <A or ovrr^EB^ the ntl-UaiMn- and u c]inirtit]y m tmiW fnfjy ttovatal* 
but aitichrd liiLifiiirnrni KKHty— vhk'ti IjiHct pri]<hjlijiii n)o(ii>A-^tuy be M 
Uuoo^ with tti^ Eund^i ibetMCkand tui a Uikf ij cdi^. (J. U. Goodrich 
and W. A. Dennis, pcmwl communkation.) 



dUfifubjr ittatioguiftheJ fiuaa <n a^uic nnnM diiodttllb of Ihe 
•e««cv cfridnuc Irpe- ll occun dtid^ omon^t butdien wu£ ii ordi- 
narily n di*euv of w» wither. Adecu young iinJ midtllc-ajccd 
Aflvlu, kttd b dianclcrind by ctrly jaiuiilicx^ tcjiJcnicu Juid (ujtivJul' 
lioa ol llkc Lvcf uid tpkea. ncvon heodoch*. Ofid ^t an tJu tffi, crfni 
ON^ ImAi^ rRfuw. <uti^, r/iify /nr^vxA. m ^ m«jdr£rr MVMifj. The 
itooll MC ofUiv li^hi &i in kdual obsmictivc j&undif<, Thfl diseojc 
tastt far A vnk<<ir tuo. tht tcmprrtiurr ii wrjiik in type, onil m*y be 
Bwdfnic rr high And olbufnuiurU oui) be j^rcxnt. 

Di0trect>aJ Dlagnocb.^ -The i^cututr K}TOpioin coDspltz Just 
dcaiuiLcd.oflcntliGoaly oiouvud (lilTcmituiti»it ivtm ihr unJiDAr? ocuLc 
f OlgrAtfJ d^v^milit, MoUris in lb r«mit;4rt k-rm w^iJd ihuw Lh« 
ponaiac In iht Lluud, pAoj^Aonri puiaBjnuig by ihc hiatiiry t-t tu ingcs- 
tioo* ood liic pboD^crc»ccnt cboncict of ibc romii^ The diKUc tt 
Kuo uid «ddom hit}. 


ACUTE ESOPHAOmS.— OctBidoQftJIy octum a> ji mull of ilit 
irriucioo ci /on^ bodioj the ipctka of comaixt pCMooi or hot 
liquHU. or. fn roani:akia whh (1i|ihlbeila or ntbd aoiu litfrctkiniu ll 
Rtty ftbo be >ocomU r y la laii^fTMuic diacuc Dr «n cxltnsiun cf * caUt- 
rhoJ procCM iQ tbe iljreai lU »yRi|4ani» «ir rhirfty dull fcuh«tetnAl 
ptin Bod Jyiphii;^ nilh *>r willKiut spum. 

EBOpha£«ai Stri<luj*B Aod DfVOttlcaU,— In <be ibifnc« of 
inmlyuft, iiubnicy In mndbir ^ii] or Uiiuid food dcmauds iirunctlUtr 
recotnse to the oai^luffcftl bou^tic. True smclun: is usually due to dcairi ' 
fiit CnMrsctfi>n rollo«Hng ihr Inf^^Tiin >:if rarmiiiiv jiitAimK. vjptiltUn or. 
d maHgnaiti crnt^ and ii nnLj coaecniul. Obiir\i(;ti(]]^ from lh« 
pnviVJi of ^nmntm oroilLcriiimorkorcrmJt i» laid, Ej]fnBuive[>«ri' , Brwmaf 
cirdiftl cfluiioti may ocmr. ^ (^u^ j/wWJ on^ 5$ ^iM^fif anfW/ 
« OMfid ftt^mifMry Mammalipti ff faitiblc itwurift<i tr nerrelit 
p ne oM i atti U thadd to n n um b in d thui 9 i^us oj lOiirUtam in ^uUr 
^ft dm U ma^itnattt f;i\mihj. Strictures may be tingle or mubiplc, 
ftha/ply dHfikval or inv<dvin|; lUr whnk uihr. bin are iminJiy r-Uhcr near 
tlw ordui or jml bdour ibc p^ryiuc. No dc£niti« iaf<>riiwtj<>n la 
otainabk viiboul Ite v*«of tbobougii>>b\itftJA tnait«r of intrcy«t ib* 
caD|ihognd broil may be dUKultnUd il the Icb of Ihc spine, ll should 
be heard il ihc Lefi of iht Mvpuib donol rcrtebre niilun 7 i«coad» 
ul Ibc tlinc th^ at miiiitlirul nf vtMcr fci ivdiowrd, and a diday niQEpt^ 
efasEnKiioa. Tbc laool ooovcniont boujpa ve ihottt'o^W^kc^v^-s^^' 

df iiijiii4t 





vnxDa DiACieonK. 





Iieftda of voTTicf; we and tn tlwdc md or vbakbooc Acn. Jif b 
the psaUKc of a urnhnil a^und and lor the iaoie nt«flOBihthe kiyr 
fl£n* vlKnild )>& tirM tricfl afid />rr»M0 niiiid^inTC^ ^vMM. The paiim 
ftlWuU b« Mkci\ it> bmirhf <1rr])ly w^ili ihr hf^ iSnrmrt fftf hark ami dip 
apinc sziAigbl, anJ wiikcni intn^mittt^ Jlf A"jC*^> ^c bonpc b paaaed 
finnl}^ and eipntiliotiily along down th« phaiyngpa] wiU dunfiudiog 
the illght obnlmaiun ciKt^unicTTd at the okohl kvd. Ofiemli 
the aaci poniMn ol ihc dnccure may be shova by fliMfoMopJc 
in^tion or X^Ka^ jjhi»kif:n[>]i> in a icilrrftnL jiHticni with the boq^ in 
silu. Pcrfonliftn durine ihe procedure U a nnbut ilrpJomble ocd- 
dcni. SrfmJjry ^hwitmt or dk-^tiiula a1>0Tr lh« tirirTuve i9d 
hypertrophy of the walls jmati. Cre<iufntly occur on the posterior vail 
near the pbarTngrol jtinclion. i.o. o[<j»aife Q» cficoid eutOap «sd 
IhfTe may be tto otBlnictive leadon*, ^utjcnlve ncntalkina ot nrtcfi- 
tion ar>(i frrej^lor rvjcurxitattciQ <iJ injccfia hMag gutric Jukvftnd 
nften fcliil, Jifr t)w vlnri \ynipli'>nti. 

Carciaoina ol tb« E»ophAj^8.- Primaiy cardDccu b tut, omW 
CMet of c^Aruoion b^m^ thx lo malignanl dueose cxlendln^ upward 
[rum ihc uirdU. The >yriip(<:irri^ aie thoee of <4iiUiiClkci aaaockted 
Willi rapid ^nd extromo <-Rui:^aibn aatl ractic^la, PerlormLioo IMq 
iIm* mi'rtiuiTmitni. ai>Tt& jiniiafiJiuin or ^ulninnarj and plniml simc- 
ttiCTft miiy oc4:ur or Ihcipint' maybe inrolvc^H LnwMKoriboccuci 
the X-Rny gtt-e* evidence of pcaJlirr taJue u ihown by ihe plaus 

SMphageal Spasm .—Jhif CAnditioo k mialljr aModated with 
' fuDciiunal nci\^>ui i|j«ca»c uiih oa hyMeria. hypochgndtia. oeuiaa- 
I ihcAia or more rarely epOepay ami c-Jtcirva. It ia aiao a ^nipioBa ti 
I hydrojihobia and llic dUf^rKBi&mdaupon tlterecvgnMoQi^f ihermHi- 
^lY facioncjirncd and tht'ioou^of a««?opha|fcal bougk cf M ialibce 
I which mrtU uriit only Icmporaiy obrtrrtoion LiijnkU am onialy 
be lakef^ hut »o]tcl food ott'ilej fpa^n. 

Spacla-I laftrumeali, - Many sfiedal iTwinimi?nt« hav« bfcn d c ri wJ 
fiirdircU iiiapnlLij^ip eaait <alibn cicleirnrtiuliuii. mraAuringtbecapaefty 
ol diverffcnb, etc. hut f<Tw hayt accvmpIutlK?>l much tn a ptvictkal 
way, A Voriuih tmbnimte porridge may m^devdivtflktila plainly 
tUt>lr by tfw X Rin 




iUtij. Els rffnui«bEc lotriDnc ncrvoiu iii«chaniua mikc* i( difiicull 
to ippli' rigjil nil» ^oraniA^ iiB Bcriv&j^. but li nif be Mid iIiai ih« Ftiue^on. 
^^MiMllErjr i)f Bniw i*^ itmrtamc utb dti<n4 upon ounotlc icLomcniUr 
bltmiMii u iBectfd by blood prevtirc stid Tolaine- whcrvu ihr ou[|>ui 

of BTM OAd fb <Mlj(<3MT1 is (Irlcmiint^l \rf the JX^ulJAT vWliviT acllOn ^flrf^lv* 

ol tlM oellt 0* the oni^i]ljr<^l ruTivka Th^tjtrr^ 4iytAin/^ ^/ft^tt^X '*"*'*™- 
fkf mwf flbwfvrr tr firfid>jSMn. dincUj or indirrrtly. mutt aUrr t/n 

VaJoeof UritktryEsmDuiution.— AV^fJi^EftT^fumrir^T/f^fitA a/ 

varutJMu tn nuiriiion *ntl vMt« and imlicala ipproTLioftlcly or 
iniilivvly inttnj iliMnum, b<itb lootl ni)(l j^nrmt. 
poboiuiai; (cmJ Iat pmrlurla, morphia, In^^, 
nifmiry, chloral. crr.K Rright't fliirtiM'. fliA- 
bdc^ vpcrniAlorrltcc*. cniitu, pydicu, sonor- 
rlvniH lyctiuru. Idhormm. fhir prvwnoc rt\ \v\vt. 
a faitiiilf tieari. typhoid fnrr, piicurn'^JktJi, srpti- 
ncniA* urin&ry bnd gpaPTol tub«r[ij]o4iti. f^lnnA 
mn^inh haminii- dyspciMJA. ihmnii.- nppptKli- 
dtu, bjslcHa And impending or ciilahtUhcd 
Iftundtcr taaj 1v mmih>n?il u «omfr a( the cnncHiloni. dih«r dirr<f^if 
ifiapkWtEc&tcd ur sirotiKty Butxaicd hj uririary «i0i& Tb^ o^iLnAry 
dVinaMtKA of Ibtf uhft« is Infgdr f^uAliUiii^, but cnuin noc Mtt f\ 
qusnliUtire mt^hoda uitxilrc rnily i bihjiII amuufiC ol apfBiaLiu uiil « iJi»nTiii- i 
iwitEisibU loss of time and «U tiW pnudur^ mny ** rarrwd smi by j *'*■ j 

Hw Ptnt Stop in ttio Urinftry E vnfni tuition. "Whrnc^rr I 

pDQOible unc first oblair^A thclot&l urinr f jr 74H<>ui3 Atl>C3l rrprtBcnlm); 
Ibe ImcliMuJ activityof the kidney moFMtL-*] by EhangviintUfiriJCluri' 
or dlAS9« tit reUied nr^Mis It should Ic ihIIixihI in cinui btntlra, 
Uic nijc^l urine Kfvintc froni thtl af the day. The vnnc passed on 
ihr Am nvtmfnff U dhrr^frird, nil voided for ihe irmamder nf thAt 
day sflvvd ud Icpl io * owl pUco ond that ;hLw:ii nfrcr rtiirmir AUfi 
upon Brtaig rhr faaatntg tn-jming wp^nttHy tnllmrd ]ri <cnHm 
inpocUnl renoJ dmwcv. nutaLly m intmtitiAl nfphriils. liic nurmiJ 
imtia 0* <Uy 10 night dcrftioa ii gr»(iy modified or rrvttted. Ordi- 
nnrflyp the dAy uHnc h ihitc or hxit lima grrmicr In ttdonxc ltiu\ ^JaAl'-^\w^ 
of Ibe fklitbc. HcEiCc AJiy mBrk:^ vinotioii U aug^cA^YC. Oi VndcvnAw&\ 

Fiff in-**! ^n^foffiit 






iaai<jkL DUOHOdO^ 





q«dnw«ii. that puMuJ lare In Oie Aay. pnlcnblj ali«r k ftoll mnl «ad 
flbnuc of lh« I I'kvey or bbuldtr. ''Mf Wii likiij la jAat okMnvolilM 

tht sormjil m&otint oi urine Tnrk« fiom 500 Myoo c.c, wid ifak 
tHiui(.iu[j ma> be iciiijjumj or |xtnuacuitdc|d>dii)|c u|Aje cxotvc tbt 
unount of pmfrimlNn. Ihe bind aod amduM <ri wMor in^josavd, or ih» 
Buipoua aDoflkton or ihr iodivIiltuJ. The muUrr itnioiEini wprqew tt 
ifiniftUr dinuniahed tn^^retion or incttAiccl loea of fluid lhiou|^ otfter 
rhunnehi ludi as ittt pcnpJniloo durmg bot wraiher, or a dkntet^ 
^iinKii drink Utile wvtcr wid ufuaJlif show a snwil d«% loitaL 

PoljruriA.— Aa incTMMd Oonr mAy bc tcmpotftiy o<r pvraiBnatU 
purdy fuiiLLirtLal (|:eyL:hi(. ciuutiuiud). or due lu bud or fOKnil 
oi;^nk iliHAjr. Tlic >nj^li'>a of largo quantiltn ol wttcf cria ch 
(Hurpiif !hil]ed«ncti u hfvr 01 gin. iht tur of crrtiin ffinrvclc drJ^^J 
hralcrk* mij^ninc and humidhr wilh W IcmjxTaturic nurkcdly. tbo^^l 
tetnpor^Lj, incmv the iimauni. ftniOmi pdymm utiullj tncUcmin 
dcluad JisruflL'. azid b eiitxHiutcnd id chono* pj^liiw uiiyliud tklnrj. 
inli-nlilkJ ncphnlia^ a.ncl dubeti* >nrili1«B or in£ipidu«. E/i<cpt im 
diahrtfs mrUihu niid mnr nufsof intcralitiftl Mphfilu* tm imtnattd 
fmu rtanlta in d Umxnd tpcd^ ^r^vily, thouj^ ID dkbctc* in^pMlM 
the toW «vi'fW tbowv Incn-afttd lotnl toNdt, 

OUgoriA.— /'oMnlep^ diniftHllfo* i» u»u«Ur Mvodtlcd wiUi act^rt 
a(ut« congMiwA. uniioof fbniu of ftcut* nrphriik. dixicuc ^mxta- 
cbjnutous tit.-|ibt]lt3 in iu aclire slagu. or w{lb dn:xikliX7 dbcaaes 
uid cociditiona produdnK pouivc congutkoi. Acaongst Uicjc «b 
otrdlor wcalcnrsK ffom May ivjurc^ ^InlmuK of thr livtr. chronic rmjth'r' 
BcmA, or prrjiun due to Abdominal growths «r a (vtjcnftnc uAcnu- 
A marked ollgurb accompanln «ciii« faifMtfoot utocktrd with icn- 
cmjQ nod hi^i bodj tcD3pcra1uic> piufuK diAnhma in hanorriiagM. 
tha<k or cioliup«(v Xid in nraity ail intfuioct 4 r«A>clM> m iA« Mtff 
f MuUftf^r 0/ vrw J5 ^iod4Ud wifk an incrMw m tdfting mtOkw «<i a 
Wtf^JUfW if^fe jCW*^J W ^ »«dn-»dnd/ f/«(*iiMB. Thtt lost smj 
he pnhvnt tratn v^irktw nt\wtf rvrn ihci^gh thr knaI rjcinfon of tolLdi 
i» nutrkcLlly iliminlAhcil. 

Fnqvcflcy of tfkiuritioa and Dyvurta.— /ncnoMf Jnfumiry 

dtr, fnnhN V itMkn, mfkif ik^ dUtatt «} lAtf tiSmy iuMf. It tt^y 

* Ofdm npoca >ud> tn [luuv^llokal Ktanafaitloo uf thr |THv*^ 
jpq^ Tic «'jshor bu ntm vnowptncd onr- 

nt»Al,WS— OILOl , 


to nmpk ooDctntmlfea and bigh jtckUly or mote frtq<u<^i]y 
untluili* or cyetltit. Rektlvtly ot Abni^luicly painlrss incrra»<l in- 
fiucnc)' nuj auonptny ■»> Iiiucucd urinary flo«. iK^ntuJ or ftbnor- 
BiU, cir c«>UiB fUgBf oi JkCtlv* djawh lucute or chrontCt of «iib«r lh« 
pdris oc ibe pvcndijmK u( tlx kidue>\ Compleie su^pnsotm, vdrn 
trmaoKMtit alwtj^ iCfious> truy dccut ciUicr ctAndy cr in icutc or chranic 
dbcftte of the Iddnex. miA hu been kaomi in ]n%i tar u pcH<xl nf 9 dAVi 
bdorv • f»ul mult tnUDd. JJ^tMiW rijMf of rnghi to voSd urine 
najr bt diir to urrthral Mrlciurr, ar cnlari^ or Tuflamrj^ proauif. 

Of tubertmlcpiw d iWM u of the gMulo-urinuT trati, intpniiiiol Ti«p1irHiB. 

Tbft Color. Fmh normiJ uiinc v&ncA from pole yellow to ytlUiwub 
nd, ami tU urtnn may be ckwilicd m pair, Doraial h^'tttlond, 

(pmmPx tfW lAtfjUirf a^Uy: palUr Miih Lt\e tpttiJU gfcvity and Utstntd 
addttft or aiUmUy, diibcti^i mdlilm ftiniuhinii mi tijutpiiDn la iht 
mlc Iftdecil so AtriluajC ts Lhc hmvy ^j|hi ol diabetic urme In eon- 
M«tlon with lu IJ^t ^lor, thai a provbdnnal rlCaf^noiJi 1^ nficn 
wfifjctu^ when lifckv the tube or boitk. 
F«T«r UrlAM, — An uiMiLly hjgb-oolorod, tcuix mil of higb ipodfic 

Bil«. — Grtensh, ]n:Ilaanih -green. gre«cu«li>bniwQ or deep brown 
urinr^ rmj pxilain hl\c: if m. ihc fbnm prorliicci] hy jthnking ihc 
Uqufpd b ycllov. Uxinc cotiuinlnjc bile may, when frc»lily puted. be 
reddbh-brown, btii oiklHilon of ihr hriwn bHlnibtrt ronvrmi Ci Into 
bilhtHia uxd produce* ibe jcrccnuh liniQc, 

Brown, BUck, Smohy or R«d UriDei Sufg«vt.— (i). BttMt^ 
Color red. RddBb^vrown, smokj'. brovm. block, (b), MdwamUi 
(i&cAanodc cuoonu). Tbe urine beoontcfl block on standing but doa 
mat ndvce Fehllng's solution, (c). Akapitmuriii, UrCoe bcoioic* bUcL 
on fU^dfoy and r«du£ef Fehling** tolutlun, (il). AniWitc Ay OMf iw 
ff^dmtU. The grrenlnh-bUfk color b Hue to hydroqolnon« and fot-^ 
Iqwi tbe exccoaivc use of dntj^ like carbolic add. naphlhaUn. (^uaiaooI. 
naordiL. «dol. cnnUn and hiel (e). J/tfm-ifiipt-f/Ayft'n. Color o! 
port wine f3i Bonlciiux. Gioea urine.— A jcreen ufinc leniltA from 
ibt ftdminiitntlon of methylene blue- Eloc Urine ufuolty indicate* 
a glt«l ocas of Lniloiyl fimducts, »s in £ltu«. <h()1rfa and typhua but 

* Peirer me? of eovna cxin io cxbisTtiiie lAd irutinK^K^M« w£^ u 
i^tinJy pole eoloff and h¥w spedJ&c ff^vAy- 


I muaripnt 



uKPicAt viMisoaa, 


la Ttff^^ Oraoge sod rflddlsh-bvowD urim* fliggw rfnihutK 
^ Of ditTVphunic mtt^; y«]li>w, untonin. 

Milky Urine.— Sijch jm >p|««nuw U wn^Uj due to pu or djfe 
EhiA fomiA n Acdineat »ntl it ca^ detnlcd bf the pntptr cfacxntol 
tfid mkriMo^k IMIft. i'nt t>l upon ihc curi»c« u ihnotf fait^iiftbEj 
iw Id Uiir locftl uac of aumi; ungiunil. ran-}> lu c3tlmT>c fkltjr tlvgrovn- 
lioD ol ibc tidnty- Chyhria. This concliiior n rare «n4 Almost 
pitthofpiomniiic of (h« FiUru «iinf;uin» hoirdnk Thr urioe ftfipnn 
lUu nulk ftnd no fal-tkopieti can be 6c!lcctt«l imdcr llic nicra*copc. 

T*tlA for FmIk. - l^hr mktracopdc ftr rrucrtttcoptc rvAmlattkw auf ■ 
lido m oiUi:lmj laiscs. CllciaLc Tests. -^Add pi>tuaiuni bfxInUc and 
rthtr, ifaak*! ilecaal &nd «TSporate th« »upntiftlanl fluid. Hw Etf h 
iMkm up, hHd in nlutkm uid Rfnuns afln tTjLjnratiiicL 

Fibriauha- - In nre ioMuKca. lu b some caM) af viBovs jcrowib 
In the hUdiltr, thr urmr j«llin; on BiAn<41ng. or. if kM librlo be prt^Mt 
a *liiky K-'9iiiicni may Inhere lu the botion) of the titm. 

TltAlfSPARElfCY.'-NoraiAl undwiMnpowd uho* «ho4iM be per- 

Erctly ck^ uit for a siUghl mucous nrl^iiU fbttiing in ir upprt 

portion, though, even in irt^hly pftased urine, fntthy phoaphAtr» or tbr 

amoTphom Hmir* siwDtTlinpt ranftr a phrilnlfljElr vdlmmr, t!ir piMW' 

pbAlri bciiiE aAMcUtciJ wllh frcl>1c add^ir cr tlkaliniiyn* the unta 

vrilh oanornrnrtjon ind iciiltiy, //nzJ>Mf> iWr««H« JAf frfvifiuiiem «/ 

phe^phtiUs and rnJuii^fj RtfuEp. P^iiskni opatUy et furWiP^ ii 

I paihvicgk and "wv *f fdnrerf Rij- ^hj, Mmh^. /*/ of b4<Im^^ 

\ 01>01t.— Thr fRiillnr «Ecr U hl«DKifted In ftharpty trM. o>B»fl- 

^ tntcii urine &nd ditlinctly and di&roctcruiltatllT nWificd in a&cinc 

' urine; ihr vitfAtilr- alktdE (lErtnwrisiJ bring piuily Afif^tt^ if pmml u 

I arc [&dol uid »k«ild in redO'rcairaJ ^nbvi the odor of brdrofUi Mil- 

pMd^ in hydrothioniirni. biltrr almond in nitro-bcmol pOiUK>nJnit He 

HEACnOir.— Tbc RAdkpn nuy be idJ. nlkaUor. vutraJ of 

amphoUii^, Le. doublv TCAftivc-t J/ ^Mm/iW. iM* /Aynrnffn fttfntf 

(IcfrmdHH A^ rrpMU\i Ind fflrl^ l^ tomUaiim it l^ mf mrary nr fifwg^- 

Hfni «nd Uic >lkal] ^mJ (potanium or aodium), ^wMk (anarMlk}. 

Any nmmonfanl urHn^ to which a fe« (bnfM of potatfhm or lodhun 

hfilralc foluiion hai been a<ldi;d rlcUs when bmltat ihc odiir ^ aa- 

mwiia- So oJjm immmed red litmui paper n«uni«« Itt 9ri|:iik4l oslor 

'Many ucb urinca »c f««Ujnuiind.uthowi!ibvapha>u)jr|]thAlc^K>]u> 
tlQB, ihnuob hirpbiA rrni litmui piwr blue, poHitily tmvvgh iIm KvlcaM of 
CD. Imm th« biLfH.--(F. C, Wood.) 

t Pfvoimibly hpr»u«r td iIk m^-iiir^nr* nf fht tfotf monoaodtest fii^ 
pbairaud ibcoilittiilnf diwdiuui fihuaipbiiie- 

utDfALYin— sraoric otAviTA-noff. 


ud*. " 


vlwn dried in tht air. A pftfucbt^t Hlkilior tr neutral renrtfon ofifo 
ApfiCAr* two or thiRc hottn ftftcr a nicnl apodftHy in vrscuuknsp in 
whkit cue the tlkolt b fixed Bod th« condition umnpotumt; btil pcr- 
SMcnL Mon-dtctclic tlkdiniiy b abnomuil itnd urine itmmoniacai wtni 
fMttd inA\a\t€ uruillr dtMAK af Uic bbfldtr or pro«ljiU^ A me-jl 
dki loiik Id pnxlutr acidity; a vrf^rUibtr A\£X. ddknlMy biil quintftd- 
cIyc dctcnrinilipn of tbt ndditr or alluttinity b clinically tuclfS9« 

SPECIFIC GBAVJTY.—FoiT orclinwy pirpfMrt ■ din.iC9\ iirfn- 
omctcr of Um UMftl type pciDptrly gmdiULtcd for tldinitc tcmpcrfthirc 
(uiUftJIy 1^ O i« tuflbomt- In IvMmfi Irrtbly pAJttrd uhnc*. lor 
every 3? C- aibu^c the alin^ard ftrr ihv mdniJuttl iiiHiruiiicul one point tt^iium, 
Aouk) be pddrd lo tiw right han<l ligvrv of ihv »]>fdftc gRvily. If , 
SMVc mziontr rrsults anr ilrairt^d nr Terjr anull quanlilia of urini* mv| 
^^■bc dealt wiih (n uielhrd caibeleriration thr bydnimetcr of Soxcp 
^^n of Uir pyinoniflpn. <ir ihe Wmphal b(iUn». rruty be te«dii; 
r obiiMZkcd^ I 

I TeckaiqiM.- In vrdjna^- dimcsl wttrk the loU<TU'ing precsulioiu' 
I ftre nttttmrf. (t). rA< uritK mwjf ir ixUmin/ to tool tr prapn ii£W« 
ciK^ tn<i^. (b), ^1U dir £iif£&fu mmt he re 
■a.r.vif tuJA ^iur papa. (c). T'Af N/inMH/ftr 
mwU 6f perjeOly dr> aitrf (d) ijq^'ih/iKfii triU <) 
/Ju^ iptH 10 prtumi it from cdhttin^ u> tkt tiJ* 
<>l «W rua r^ te rf f. (c). TAc j^i>: x/«rj(y 
ihi>ia/4f N4 mi^ /ri>fM Ifi4 mtnuthi or itM tur 
j'ji f . iln uLacrvrr'i c)t briny At thai level; fftlte 
rvAdiiig* teoult tf one reads from above, bouuM 
Ihc fluid ri«v iiLifthrly jiVirg the iirinonvier 
itcart. ff), n /^ ciW(>Hn/ 0} urine it tmo//. A^ 
pfeximaU rtatUi m/iy br t^tttfttHfii l^yailvting rt*gi- 

Nrii, Ki.-^wniiK viw- titMiiy U /fooJ lAe lAjfrnffjrivf anJ mMpiyimg 

Facton Det«naini«g Specific Gravity. The normal fijcum vuy 
fma i^ij and IjOIJ, the aTm^e l>-lng hrtwrm i.otJI nnd r o» 
llyvCfria u)d the ittc oi dramic fluid* or druj^i mny rcduix it tu i.oof 
and VI dUma? 11 virim fnim t 003 E» i,oAex Iri i;rrt»-ni^. Ai;,b tpea^ 
tnn4ij pornla to tari<c hemurrliagcs, j^rofuac pcn^umlion » dianlimL 
irrn-, a»d MdMn m^iiut. Low ipfttfit gravity lugg^tu chronic 
BHgU's diMcaie (patrticularly inlerMttml nephritic), dialictf* liu:^^^^'. 
Blld. hptUBMm A« A rule, a bw flpcdfic gravity t^co^mpu^cb W:n;&ac& 





^ cicntba oad & kigh jpcd£c gnirity> ilimLnislxeJ «intt^ 
many ocvpttocu 10 Ihii rale, mooy gnre dbuuci being uascdaicd iriil 
vant urine uid deAdoic rllmlaiiioii oif uHiU ■brrrsu ritabdq mtlMwr 
w»y show An c&ormoualj incrcucd cxcittjnn «IQi Ihc bEfEhoi Kadap, 

. BAfl Hkhrfrs En«ipiiliiA an 1ncTr4v4 artioiint uirl kiv tpcdSc 

URINARY 80UDS.-/^«rma« ntiim im fJM A^iirAy ^mil^Mnp 
I kWf j^J jhor4^ i^JHiuiJi a6cnJ 60 gm. <fl %Mds. Of Itioc ftboQC 35 ftti. 
are cirKinic and 35 flou. inorjpLnic A roti^ cMinuliod cl t^ 
of solJtts ^r looc cc of urine b made by wfnK ihc 
Tnpp j.OQr or of Hibcr >^\j m ft mullFpJS« snd the IM tm 
of ihe «p«dfic gnvity >« ibc nuiliipliand: e.g. tfwd&c gnvi^ i«»: 
ioXi^=40ipn5.pcriooocx, Twcoty'fourhcHirmrin< 1500CX. 40X1-S 
^=6ogm£. Of thi^^ot^H/ ) buna wbidi should be Kf^miclyettknAlc^ 
Tie prittapd inotiomk ntbstanca juv: HO (9.35 fro*'), phoi pto fc 
ftdd (9.5), ndpbutk add (1.5], niiric *<id (1.0). ooatk tcU (0.91 to 
ojOa). «odium (&o)t pt>iusiiim (^o), ttnununU (0,7), RiM^pioUi (a(], 
lime (o-i). iron (coot t^ ooo}). Tkt &r£«mc si^$ianut am tn |^»* 
urcA (30^), csTfttJAb (1^9), uric add (a;), bif^uik tdd (0.7). Trtctt 
of « Urge nuinbri of urguuc nibiUnu* incIadi&iE Uic puria 
nwke up tb« boUiic* Cor ih* orghnfc ix;n^i}>. Tht f*ihti$gU 
ikmcej Alt the albumioi. bbud, bllr pi^rni. bile adds, indaKTl 
ftceton^ dinccCic «dd, cr^itin, kuda- tyroob, cvbo-hydrAiej; pbuol. 
OKvot «lcai*3l urobilin, ehotnirrin. ledtlun. dkmin*. mpbrtEri. Ht%. 
fatly adds, ImiIc add, bdAoxjtiutyiic add. Of tboc iodiMi)!, tceUinc. 
Uaic acid, fatty ad'iB, pbenoU crcosol, skatol. urohilin *nd ev«a aJb«s)- 
iooua bodies maj be prracrit w i/anMcifify wmu^fM^ i>r v^iq^*^ 

lodoiryl Onditan).— Thii nonnal urinary dirnmo^ui rrmitt ffum 
dbumiacnu pLjlK£iiCtioQ in ibc prucDcc of bacteria ud if Cooftd In 
iIlc urine in acta migffMUt intcsELoal pntTcfariinn. aepik pncciw cr 
Ihc cxccuSve £n«ttIoii of ltd nuftl. C £< SLmon xcpurU an auxat in 
bypocb^otbj'driti anadilortkydHs and tkf hyfinM^rtkyinA cf arimm 
giutt<i iitffrx ahd an «cca» b found b i>^Jhi^ fever, appendidik 
((hmnk or aoAe). cancer of the atomad}, ^tcritonitis, cbponic j^Miilk 
and timiUr condldona. rtacktmi Jti mAriiHvn in tUiMi amdIUttt. 0ft- 
t^uifi^ in ik4 ki^tr tai^n <v ^m/J« ctMulf^iilUfO db«* H<>l liiVfrMfc A. 

TM- (Jatfc-SCokTfs) — <a>. r<>l# a^uo^ fdPti 0/ 'Af iir*fl« divJ 
jfrviv kfdriKhMc\oeU. (b). ^i&f hiv v Mrcv ^^ «; 4 iJ/arcfti 
Mfnljm ^ ffii'navV fdida«i ky^htfiriit, w «/ ^mmim mA /m«9. 

raufALV%a — QtiASfTTTAnvi: ixjen. 317 

SMn, Add 1, M 0/ cUm^n> thaJu tk*nmfitUy and np^tiU^yitnd 
fttf aUt. The (khfef^rm tt^n sJutn a t^ptk 0/ wJrtr varying ttrfE* <fo 
4i«<M«t #J imdic^it fratitt. Pt4Mjivm icdidc if prcjeni may ytdd off 
jt^ktkH e^mtmg emd rcdeint a Hddiik ^f^^ 'Itic ohMrvcr «houL<1 
flriiUU a wrm^ »lftDiiud bjr npraieil oLflcrvalium muiig always 
dw ■■» qusniitka of urine «n<1 rftgmu. A mon accural* i<«t 
involra thi* tm* of a xmill ■.mount (not an rxcos) of Ind arvlale sel 
(ac^) vrttich reniiivc5 the urniiry inp^n^U m the pndpilAlc. 

QiuiitllstlTe Tuti.'^Sinwat'i mrrhcKl Thlt invnivn th« we of 
a ataatUrd color Bolulbn obuined 1)^ d]Wo^vinit<>ric tiiff.<)f C P. b^lit^Tli^ 
in 1000 nc. of chlotoforiB- I'hig Kbobld bo r^arefutlv k^c<] »nrl k«pt 
in llx lUik. Tile of uriw Jot.c..add5<.4:.of rta(JatrUilir!Ki|.(yo%), 
whki predpiuiM the urochroiae. KUev. Mki 10 cc- of Obennayer't 
mpnt* vcfrh to ex. of filtniTt (^=S c.c. urint)- at^^ 5 ^-^^ a' chtofo- 
fomii CCffct tnd ahukc K^nily for two minDlo; Remove rhlorolorm, 
•dd VioCbcT 5 Ct. «f tunc &nr| sn rnnllnuc UTilll nn <clOir U 
exInKtc^l' or the ttilorofoTm lufct) take 1 c.c> in lul>tubc> add 
chknil«inn guUtaut until lt« color comtponda v.-t\h thai of ihc 
tttiKUid aolurion (n a cnncml mbr of equal ralihrc both bring Mtl 
aicainjt a white tacfcj^roiurd. Tbc intal number of r.c. of chloroform 
uwd hoih Jii ntnrrhn anri d^lutErin rrprf^u-nm tK^ nmnrint mnialnfajE 
I m^ ol indigo. By mMp\yv'\j^ the total amount of tJilurufoim uied 
for eElnctice b^ Ibe acnouDE UMd lo dilute lo a itandard color and 
dividini by i«v nhich cnrrespoods to Ifac amcnini subjccuJ Ut cUlulIoti 
we obUJE Ibc araoutsl ticreaMry for complete siaftdftrdizalion of the 

IHDOL fcxcntcd as potasai^m>f milphatc}^ WHic-n Tot^nd in 
n;b4taiKV In the urint Ihi4 aiEf:g**^t4 ivnn-n^CA] tisrtib; iith«fwlM| 
the note ataiciaenu and test Apply ju given u»J« indox^rh 

Taipt iMdotm Svtsia'tte.—Chciffa rtd mititiim . Add to tht urine a 
lew dlDOi^of ifilutt ackdJuin nllfile vIuIluti and ifcntly pour ildoitn the 
iMv of a tvbe coatAlninf; ctilpburic acid, IndtA yvldi a ^rpU etii'» al 
ike f^tU fi) <mi<KK a dilTiue pink on nbaklnf; Ami blur ^^rn rm nniiral- 
intioc with mlhun bjdnile-t 

SKATOL VicretMlMatcalolcaiboTiicaid-l).— ti uvoTtbnfmembrring 
tliAt ilib ^uliiUrice !a c^jctiaJty abund&ni in caje^ o{ lubcnuloui okci- 

*ObrnnA3rr'i rivpnt- C F. HCt 1000, Irrrii: fhlurntc > Tfii> Forni« 
■ paiHMaeiiL binliig jntDbw mUlcic. AtcunteqUAbtiUtln drunattMlon | 
ia not c^aanlial i 

t Thia la alniple and niiGdtatIf dcKcate bui oi^ur tosia audi aa that of . 
Ebrlich vU abov 1 part of Indol in 4oo>oao parti of urint. ^ 



atioa of the iolMliaef, guTric ur iaiMliaal <ardoaan and {MKOBaDk. 
■Ad b not (nacairi In ilit oilier i&cwa ^bowing an eaam of Moi)l 
<y. C- Wood). RoMobacb-c TtcL-Add mtrie •£»* ^«tf>l^ !» 

ftiiffifif urjnr; a ftiir;fKnrJjf rt^ <iiLar with a bliiUk nd Amqi oa tH^^^ 
imJEcale* skalol. a rcdcJiih or UrownlMi red ifl uauaUr dvc to ivebilk. 

nROERYTKRIff.— Tbi» mnnal utioftry pigm^iil i« Lnrreific^l U 
kbtilc i:ondiU<>nA. fiout. vuiDiu djripefvdc oonditincs vid after cmehb 
Id Ipod or tlootholici. ft RiTCt mi onnivc color to th« ttricke uMl t 
n«r ibi ici untie wdliociif*. T«st-— Add C.P. Milphurfc Add gui^ 
laiLm tn !};« iirln* and a cftrmin* rod tobr n*ctbn nppcoiVi or. ss«r 
fiink urmla dripd or filtcTT^l may yirifl a brigbl grcai coldr wilh a 
drop of sodium bfdratc jolutiua, 

UELAiim.— TbU brovnivh blade cubsttn*^ prodticca a d^rfc urine 
VI one duieoJaiK upun opowirc to Uic air> Hu* udor is iTirrnMSr'T 
by Ibe flddttlon o1 bravUiM vaUr or knic cbbridcv 

UROBILIIT,— TtiiK or Its dinKnojcrn I^ a normal ooiMlhiient of 
urine dEhcrffhcrkfrcsbtypuMdocftsdcTdopcdbroniUiknorisUQidbic 
vmI k probably thi* itnTobUin of (he ka^. lo «r«w it imttcMM w 
acute uifei;doa, lead colEc, hc}iAljc ^Irrti'UA. pcnijcioua aovnuL ioAEfiiil 
hciDO«Thag», paaiTc eon^fon as in a u^k btatt, ibe vgortm of 
audi aulwianru m aDtipyrin uiil EintiMiriii. dilc^Dfann inhaUlInQ ind 
ibc ini^ction of lubcrctJir] <Wood). li may iU»o be ihc ft 
ol, or altcraaiF with, the bilirubm of jauodlfe coiutlrutbig 
icUnis. moot frc^^uent b atrophic cirrtioaik cftrdiweu vkd 

Ttet-— Tneai jo c.c^ ctf uni»« wKh an or^tiaJ toDMuiiof porv^ 
cva|wralc^ antl iliw^lii' [be iTi»Iduc in tfnmg idoobol; ihc nsolllaf 
tolulion shiyM be i^dc ycUok aad thoir a grwn flioorescvocr. 

Spec^tTOttcopic TeM. — Dilute tirine If upcamrf. add a fcv drapaof 
ilioclurc of JodLdt to each loc^ of wmc noil the f pccU'OfOOpc wiUdhov 
a hsixiA hfXitttn ihtr fpt-^ri and hltir if urtjljflin liacV. ttoi hsckrouo^M, 
be j»ft?*:Tir. 

TH£ OXYACIPS.— Thne hw lb« caiZLe Kgniftcaiicc aattdoql 
and have uo spcviol dintcal iinpotinncE. 

AE.CAP10IVE. -This rmrt KubtCfincc hai no diaicil imftortanra «vdc 
fmm Ihc fad ihat It ptfodurr« a nritv which darLrnt twi tfAndiag aad 
rofiRKVi FthUtt^t jofulMO, tliotiKh not affoctinE fcmicniAlMn. plxaTl* 
hrdfuin. bkmuih and pobritcoiuV tola. 

BTDROCHIffOIV AND PYROCATECHin.-fiub of ibcst vd>- 
■Uooei ptodtuv a vrin« whidi darken* o<i itnndirifi bot ore ol no diaical 
Import Alice. 




itutl notm^ urinuy pi|{m«BU oElen auocisl^rl with urabilin und uro- 
cryihiin. The firu a die diicf jrdb^ iir -xmbcr |)l}{mcnt, il^r 3ca>[ttl 
tcAB/t Mid rcdi (Urobilin yictd* ydlowuh brown and urocryUirin pink') 
C/fddbmmf Ci iwJtfy prftipLaUd ^ Ui\d affUJr ttytuiiim IrAvita/sa dtar 
■tfte ImJI aJafhd h t^erif^to^ ^x^jmindtftt. ilttrmittopt'tphyrm ia 
ofUv «xrrre«<1 in novt in chronic u*en of IrJoaaF. jt)l[i>iooal. ictmnAJ 
■od the liLr, the urine bcici^ d«rk browB or bUd 1:^} Tv^ciiri X\^%. Il 
■ psofaablT' cimved trooi hcnuUn and may be dcmonimivd by Solk- 
owdd** T<at— Trc«t ^c^cnf urine with &(niUurrcrirML»tln^iifrt;vAl 
pftrta of A Ai>hjtii>ii (jf harium chlonVic { ]</.</) and coM Mtumtrid fe>1u(im> 
nf b^ritim hyitnt«« msh Ihi- rwulling f>r^LpiUTr uinih v^ht iiri<1 ngnEi> 
with ab»oJiit« akobol and »tiakc It up rcpcJilctllT with a Karm aoluiioa 
f r pi T w en li fig ro c,t o( >lcoJiol *im1 f>-^ drops of **CI; a red tEcJcI oqJot 
nsidb uid 1b« viluiion yltldH the chomcterUiIc: itiiublc [injuii of uld 

Crf«Ilnln- TMn ilrHvatJir of ihr tn^^.'^linl utt^nU IoILi^avik Ihr un^r 
Uwi 13 uti-d u to vAriitkJTt in (jiorlion^ hoih in hcatth ^nd duicaic^ 
It b CMilf rnwgnused by ihe imtoiw rrd color prodtioHl by adding 
4 UiiJc ulbr«lcit »alulkin uf I'lcxlc ocM md n few dn^fis tjf mkIjuri 
hydncc (JaiV^'t t««t) to ili« iinn«. 

Vufiout oihrr subaunns cJ ^o clinical hn^icirtBticr bui tdiicd lo 
ike CoRffMni! orf:uiic compotuiib sr omUlcd. 

TOTAL KrniOGEri.—|Wortn>nii(lcrffigurffl?inrluricmHd the dm- 
TAliaci ftnd inxporlw^e of the toul nitrogen cicrelion ^hcruldbcconiidercd. rjftart 
Whde the totJit nlltoitenoUH output of Ihc htiman L>ody involved a ccn- 
sidmiion of the ftcch lutii:» iirid akiu aa vttU at) the Wnn-frv ^l^f'r"■■ 
lAf /otf tiuT lAaf l«if pfj6r/virff yrtnv 91-93*/^ W '^'^ ''''^ m-^kf! tht 
uriH tf/j ceoimiialipfi CW ftimary itiruidrratioii. The lirallhy aiIuIi 
on a mned diet aeoetes o-* s^nt. of luttoKm per kilo of body weight 
Tli^-.-'-friMB 1010 IS gnu. of niirogfn per d^y. About iW^ nf the urffliify 


aJIroKCO i» iirm,f 8% is dcrjicd from ammonu. crcAtLnin. the yMjin 
bodl«aAdthrpif|nii(^t«,irhde(y/^rcpn««Dt8hipfiuncaddaiidtmki^owt> i>timdTr'-i>. 
sulHUiices, The niirii)(cit fiLittion menauja atruraitlv llw varia- 
tkin:^ not merely of &ilrof[rroi^ bloke, but of body ttjuitr and faeccc 
the fnriAboIic pmcmDL Tncmutd (y nittogmtota diri on rxm& may 
ncvcrlbclEM be retained So intrt (or Kveni dayx. a fact which haa ntA 

*Na/ftnP (brk hind En ihr >dkiu, ilKTMElrr unc bciHnuilhvyclUitf uul 
I tlie 0fcd IntooLicl idth a Biliier buid in thr jtUuw, 


UFTtlTAT. ntJUlTtlWI^ 

Hor pr*e- 


ircl bctP cipUincd, Jncrifiuu^ fxir^ifli aIw occun kt bctiCc lofc 
fnvn (cmpt^ng acijIp yrllov atmph)' r>f the Kvcr). in»U|pi4at 
cluonic uifcc(ioa& ponkKiua anjrmii, cciiphUi&lnuc gotUt. 
tfac l«ukjvmifl«, i«Bi>rp(ioo ol cmdaiM diiib«t«i teaipidistfe 
poivnifig «niJ indeed in pnokally 4]t £xtaa ttKKtalti wU 
«nu^iiifuw(. maintanlian or tme m ht hxk mftahciUm. DimiMsM 
txcrtlum ootin In ncphritb, dkfflttH ol thr llvrr Mid tn fWirtU*' 
COKC lr>na jiciik discuo, thoutib Id t^c former if uaocUM *irb 
mufcvd ilburarnuiia tht urfa* tnnv thnvr kr Appiivni incnue H 
the albumen is cot rcmoTcd. In nrphriib capctuUx the stoinacfa. 
int«ttinM &nd »kia mny take on ricariou* xctivtiy and tbt fiem 
will ihow incTciicd nitmpm conicnL For ncninv wcKle> nrrful 
mcajiurcmcsU of Ihc nilrcj^n IniAle at\d of thot of Lhc fcoes. aa welt ■! 
urinary nTirrij^ Ta rrrcjMTj afi^ tbr Utv^rintis uid tlmr ooiuui 
prtxras a iU adapted to dii^csl wort, A aimplcr mttbwl b to rfjg 
the pati«nt upon a milk diet viTh a Lnown nkrogm cootcnC 
duly ntlmalioas and Utrn give a ricb pi<ofedd mad. The pf«n| 
of the oitroffonou* inocose will meuure Ihc rriuJ actirltif uid pir- 
mr^hMlty Mvr fn rrnAin fifv^ ni pftn*nrfi^*ttmA nppMff*. iinlna tbt 
4 liilurbing elements of uncnucdiiircaisjiad mcrea^d eii:n:tioin luEcrrcfK^ 
For a dHcripdon of tbr cbemical proonsn involved ibc feftdn li 
rcfurrd io ibc flpcdd worki dealing wtlh phjaiolotpcal diAnttfrr 
UR£A,'^lnih«nonnal individual The una ccntent VMJt* fitjn »o-]o 
fm« In 34 ^i>nn, fr jaUimj^ in nmr/y nyry ^AMiir Ih* JW»9 0/ ipltf 
fufroj^m fiXfTfJi^n aJrr^y /;rt'en. Women exoek InB than mrm, asd 
In vfi^NAriarii nr poorty fed pilienls^ or these on a milV diel. lb* UDooni 
may not ooecd 1 5 gm$- a day^ Aa bcfoic stated it rcprc^enU 86% of 
the Iota] nitragm (vefcetable diei 79%, rich prot«fd dwi &;%). il»m ai* 
period* of rtientlon lasting flcvc-ral days, and tE may be incnued by 
txn^ta drap fuch u MtEcylic add> cafldoe, and qutehw. /n Jwouxr 
<^ lAf iii^ tk< bft^ rrcrefi^'i i> mnrr f:rettlly diminUfud Ikam m £fcr fti<Ui' 
nAn^C<^ leudo aqiJ tyroein brinjc ccinddcntly iccrcued. or. In aoiic 
pvocetus, an inaeaserl nmmonia exoTTioo rrpladng the leuela and 
lyroab- In all fonn» of BK]elil'« dbr«i»e uve lb< c»iiy ata^ of par- 
cndbjTnatO'Ui nephritJa nru in diininUhed and aiao vtiowi m^fh^i peri 
odlc variatiun^ Ii is !tup|joBcd Ltial nialDeil unn tn wdli inataQCVi 
li ratponaible foir Ibe perioda of diuieaU or dJAfrhcn 90 ooinmoidT 
•een. A tudiSm drr^ In uiva ii often noled in nrphriilt ol all hln^h 
nnd 19 a donjEer lixnal ihai eannoi be duirr^rded- The aalbor vroidd 
tfrongly diifer frcim and indotd, rpvrnv ihe vialomcnt nwk by cnUu)— true aod. 



cn ttai m trcuj tliar^x uinx dfrtcimmAikuu Atr Icsi im|xirUnt 

than mU ind aJbiimin. 

fttuc^ ttcrc found lo ocancitk in every lni»UAc« uriih periods oi W 
una «KT«lon (<Wto (pn*. p*r imo r c ). Tn niTicn inrlH«nrunal« bul 
trodbkBome gMric Btrnptomj, mutol mmuthauA uid hjrpDchon<lria 
were fouod to coinci'Jc viih Lh« Mmt qcikSiIvq wad in oil cxscji wtn 
l»naplly fcUcvcd 1>7 tmlmcuE thii» dinxird. In vrenl Indjuices no 
RtTiKtunl disc±K ol Ui« lidncy vu indinipccl by the elber urfnflty 
ficHUngi- TAfF Ar<J«uA^ c/ urn b otk? <i/ tint nmpUxt and mast 
imfmiani of «!/ tk rm e 4 l kH9. The nvxt oonvcnical method of quan- 
lilaliie lesdng t* ifaai of Domvui which is uiffidmdy accurate leer 
dinkBl purpcnei. 

I>eKriptiaD of the Doromiu Ureometer.— The Dorvmuj afw 
pmlu* bi much yntd «nd tnat^hX* at a lubr cftrrylnjc a VuII> b<^ 
b« and M uraduatcd th«l och dJvWon <ijmi4i>iinil« to o^ooi j^, of 
mraa*ir j M>8f<H^hy tlif vnliimr nf filinpTifvolvrrlanVj* ¥. Thvre 
U*bo AmullpCunnf- m;>ple -cjppcd pipct hrdJingicc, of urine Itui 
fiBftd «{lh Ric^'A hfpohTomilo solvitjon* to Lh? nurk on Ehc loTigArm 
of Ibc tppftraius. ftml wwcr ^liJnl (o ftW ihr rrmAJddi-e mF the aiiri luid 
Uw IcFirvr part ol thr b«U). I'h* pLpMf ^ ^^^^ ^^'p'^' '^I'l "nne ifrtfJ 
/iM ol^Miiiiv or 'at;^) up to ihr re, niirk> tfmt ihr jvn'm I'arrMfy 
introduced inlo the bend ta Ear ^s il will ^ while hoMing ibe mcuui' 
(nf tebe perpendintUriy. and the oonuineit nrtne r,\ovly sad com- 
jjMcIv ilischBriced^ Aftei the evolution of kos h complele the nuioW 
of diviiions b retd off af mtlli^Emnc per. r-c- nr the rttniit nulttpljed 
by loo lo obuin the pcxcratdicir, 

URIC KlD.—UrU jfid (o>i to o,i ^n:. ibilyr As 4 w^icnvnt, 
uric la'd ii raxUy rcnkgnixetl by micrcetn^pit riaminttkin or by the. 
nwcrovopic dcpuii of ■ iub«ijinec rewmblJcg cnyenne pepper. 'Hic [ 
condlilon* favoring & ark odd di^pfwit at?— (a) Cfmantratfd uHtu; 
(b) ki^k midiiy: (i) Jefitmty of mtii attd fymtni; fd) cuoj of- 
$h€ wrU tuidi (e) rUk froUid di4i; (Jl palhotu^U in<rnijt pf wrfafr^- 
ism. Tbr appcannce <il Ewcb a sedtmEut b a ?LUi):Er bi|«umta b aug- 
gotivc of lithcmrA and ihouM call for lurthvr ui« cctigadon. Thci 
amouai of lufc Rfid In etniigrams coniAinH tn udi tifre of th& 0vcii 

•$f4, t, CnKfc S<ida i» »»(! [K«ltlU1 WiFrr t^o. ^[. [J. Brnmin t' 
PotAtriilM Brcnidr r, Waift & To nuik* tr<a fnhitbn^Talw £ C4, Ol 
fw^ and 10 ikf matarr wkl 10 c.c^ at muta. The? kap urU- 

f The tcatrumcae tan >aw b- vbudnnl wiili m Mt»d)rd hulltiw am «Kxh 
a iBuiob Kvn to huld. cneaivrr. and rcfcdv ifac aoKiunl (A wW uk^L 


V»1ur In 







urioc may be a^prtrximaifd hf nrakiplpag iktt last two aucobcn ol the 
■{tfdfic gravity by 3.* Any fodinncnl iruy be laboS ttv urk acid bf 
heaitne with a drop oJ diluic nilik add upos a porcelain pUto; wiili 
eriporalion a rf<1dfih mhivr apprara iriiid) ftrlbc« a hnotifui derf 
rfJ «ith ctiluic atfimoaU. ^tf^a/ifoDrM tert;— TWe ia k» occutalt 
tink}^ tc&t vk! Ihe complicnud end Oou (Hoptina-W4roer, etic) an 
ridl Htlaplctl t4> ihc pnclhioncr'^ use tn view <if the iligbl cVokal valtx 
of iho procfidvn. Sul one appraximaU method will be gL-rca an4 
it. Kkc oiher rjUBHiliaiivr xati. m\iw be applkd lo a ponlon of ihfi a^ 
hoiin uricur Ic sho* an txitm of uric adiL 

Htintl'a MeUiod.— To mo <.c of cTmt urine add lo cc. ol C P, 
IfCI ani mil thotTOughly. Alter 34 hou;^ filter dirough a <by C3lE> 
pupcf ^f kttovm tma^ht. Dry arid re-veigh. The difleivBov io arti|t>tt 
npranrta tlie luiLount of uiir aiiil tfi cadt mo c^ uI unoe. 
' THB PURIIT BASES. Thne eubftuncva an deijvtd cbkAy frov 
th<? r1r-L4ruiiiiiTi «f tt'11 nuclriH hence, fmm nackbi Thrir fstiptttkn 
U djf&fuU ai)(l tt prrvnL of »lijchl dmical iutportanoc. 

URINARY CHLORIDES (10 to 15 ^il dulyi.-RotigbTMt 
^FQlci iIlc urine if il be utA [^jfocily dnu; leinuvc allitimin by bad- 
mi;; if armoury (a Ir^a do«a aot matter)- Prcp^Tt a boIiUioa of shtt 
tiiixnic aa<l tUstiUnl wafer (silver i part; lilsLiUrd vrmiet. & pamt). Add 
Uua. dfop by drop, to a portioii of the 3m3i>cicled urine* wJUtk W ttm 
ATiuioi Mfi a Itv dffps 0} nitrk aHd. A tttwdy fttdfiWt imdiuki 
mn t MJ dUivKfN. UiJAy turhidtiy ^r timfk dt^Mnat fth^m a marU 

HieTfllur ^f iliis jjrD(T<]uit in diiucal wurk arve» fmn the fan that Cikr 

vM It marked dimmuiicm tr iettti s^imt sj ike ttriiurf ckUrid^s^ Om 
«/ ikf first tvitkneti of ntetmUcn m lehar ptttmmtmti^ m ^ tkt ntlawr^ 
iiimof a» fxudatf nr tratuvdukbHttt ^^4 rf*tf^n)n<tat AihrittUcnUi. 
Tticir falimaluu a ubo of grot value in making n diCttoitiB] 'Hnr"f*f 
bciwfvn menn^tii ukI tj-pboid fcver.t th^ beiaf; markecfly rtdiKtd 
in th« tormrr. and Ihilr affrdn! in tlir Latter dbv^M, Thry arc ata) 
greatly rcducod m ncrjte rbeunutism and their diaappcuancQ wkbout 
added JcJni Envolvrmpni aiiKg'^i* |v^rlairi1iih wtihtBv^im. Id noraal 
Indlvidiiab a rapid increaK of body might foUowB the ogcalloa and 
mmtion of il»« diloridca kt quanLtty. a rvduction of v<^t iolbmif 

* A« a matlfT of fact nffilhrr lh« ntio of unc acid to itfta MM |o Idal 
oltragm il <oiu4ant. 
t E^ S. Wood CLcdUfc nolcaj. 


iiuHALnt»— raeonunca. 


tfceialMluctbvirSMmvD. Chloridci are tnora orleaxUBBintabedb' 
Mtanvliov ov t mBk ilirl. in Frbrilc i1l>«p»ri inmmlly and by Hrrrrr 

rfJjAUf is tafgviy Jw Ic the filmtii^ o/ tAhftdet IM fAr Usrues am^ a 
COTUofMnl tftttwi w/j Ji 'im 0/ swkr. This tdcotujn i> farDrciJ hj ibc 
cbonical ootnbinalioD lienMd by iht cbl->r]i!<«, th« rvUiivo itnpom«s> | 
bUiij of Ibr kidiiry and a poor rSrcubtTion. h*n\i^. [f bjiA Tifvn iu^j^lcil 1 
lliAl IB bdtb i&compcniBlcd hran disvan and nephritis tbr amotiot of 
fodbvn dbloridc fafcedvii aJhould W rrduird to the miniTnum. 

A Simple Quantitative Test (^[olu-'i) mikT be u»cd if dtAlrcd, 
lit trrOiTt being ««j &Siabt u not lo flfTcct rts cUiucal valuc^ Tut> — 
to ex, i>{ uniiv frtirl tivm ^bufiiin &rc diiulinl will loo ia-. uf witcr. u 
lew dn^ ot potueJom <luiomiitc KjbiCion adiditd («nmigh to produce 
ft yellow mlor) and \ht wholf |Jax^ in a fwnvlain cupstLl? Ttiu 11 
Lhcn iknted mUh a sUAdanJ uhcr nitmic >alution(Af;NO, C-P, 2q,o<^ 
gmt to the Uirr). 1 c-c od which nhouM prvdpltatp 1 miil|(nim of 
»diuni dilortde; a pcrtaiACAl and diffuacd omcLj^ ixilor ciiila llic tilra- 
lioa and iaulti[4]ing ih« ciunbv of c-<. used by 0,01 !:iva the CLnioum 
of dUoridcai prcMui in to c.c. of unnp. 

Tbe Centrifugal EotimAtiofi. - Purdy'ii mtthnd ia limiile luid cUn- 
•calljr niffldm' Teat.— FUI one of the jTaiiuAtcd iulir« with urSnr fii 
tbe 10 <^c. mark, add t$ dn>fia«>f nitrit: utJ tu jiiricnt prtciintatioi; 
of tbe jibotfibatt* (more il ihv BptciAc gnvity be hi^}, a'ld (i-^) 
nilnlc <ir ailvcr aolutigp. otijt tbutmigfaly. and (cnuifueatjjx: at higli 
jpccd for t$ minutes; normal bulk pcrrcnuf^c rradbfc ia from i^ia 
axid ejLfh riiviii'^n rcprnipnua.tij by WfiKht 

THE PHOSPHATES (normal d^rrtion »,5 to j jcma.). Uriaarr 
pboofilMrfc jtfld i« mrt with tar^y In tromTiJrjaiii^n with potaaijum. 
•odiian and aiaoonluin (i). lo a ksa »iitnt wiLb citdum acd mo^' 
ncatUB, It ta denred to aome c^ml ffcm lisiuc and food oucldni and 
b biaeftacd vndcr a i^egctaLlc did t>T a rit/i jjnitcEd hiukc The Urm 
pfcoiphfltaria is probably a cnianoncr Tcpn^KtMlnjE merely a <i>nditKin 
of wdurrd tmn^ry afiiHcy vhWh ff-adA 10 Thr ion«iant nr almoHl nin- 
5taat pctacncc rrf [lif pho^phalc^ u a prccifntntc-. Il ii met ivith chicAj' 
in cam oJ nrura«th«^ii or (emjionnly in nervoua oventrain, and may 
accomiitfiy hy|xtchIoih}iJna^ Fbc^apbatrv air rnidlly rrco^I^r-d by the i 
tncChoda racntiaiied on \m^ jj^- Tbcir qLUfiiiucivt^ drv«Tmiriatii>n ia , 
4iJ too liltle fanpovUaoe to be detcribod heir- [1 t<Tiould be rvmnnbFrrd j 
that a pboiphadc aDdinMOt occurs frtqucntty tn^xcnna] iodividuoi» | 
And many " phcifihMvriiu" are Ifttio moiv than the tr^vA^ cA Trtf^£^cvA\ 




Msrrau, ruowMB. 



1 limril 


Inirmpoction and ttm tArcfuI Alloitioa to the appcamux <kf tbc tiarif^ 
urinc^ In anmoniACAl uhnct bolb the Bsted afxl thr volalUe idk*li 
<i»uliinr to fonn ihi: silt^ if) frtv|urnt1y found In ihf prrdplUAr. 

TBB SULPHATES.— NoRtui caurrtton (1.5 1» j cnw->< Tliaecau 
f ftber tut pnrfodined ar u «lh«rvai1 or ^njugitc fulphalOL Tlw (oAwr 
f\in ncwij pMslltl with una nbik the lAttci Fallow bddKyl au dud; 
MloJiutiiybutsU^ftUWtioabere. ^1ieie Intlcf mt^ hoirtvw toqiit J 
bj ihe IngnifoQ of drvf!* wKh u crvosoj ot phenol and |ihoapfaamai 
and f>ccfts^onall7> nriLhoul a& indos^^ MCttM. 

THB OXALATK.--/1ii0ffar<MdflnmiiAkA fiinikBv 
tusj ikehvd u avo/Mrio. die diagpoflu of whidi nubucd chivdjr 
pBMcacc oi caldun oxalate ojvlab b qoanbly m the urinuy 
ThoE txcat tuuaUy aa a roult of |CM^io-iii1atii»] dbluibiaikte 10 
tb« ftirinploaift iontiiTly atlributed lo tl»«» an aaon profwriy wmbed 
The rd&lionof ihr ciyUal* ft* the formation of cdctili uid fhrtr snggnike 
of dutufbed mctAbolisir an Ihc only diniol f«otarea of EfnponMKRi 
DurJcip ha shrmn thnt ihcir prr^Gf-nrF indicnln ataom 95 ttlDI 
uf oialic add lo looc c c. irl i;rinc. buT thi» unotinl dott not cxi 
DAEiinum nonnoL Very lnqu«ntl]r they an anodoled vith an wrfrati 
cf indaxyl and Mmdimeii with incmucd ifthenal sulfiAiatA irirttam 
incnaje oi indciyl, 

IROlf .~ThU cjiat \n the anav tA the ami^unt of t tBinigram btf 
ll« eatuuaiiuD hu i^u clfnlcaJ valine. 

AMMOftlA {ofifmal Oj6 10 r,9).— Th» proporlLon of ntlrofea 
dcrifrd fmni uniujy oramonia lo tutaj nitTDgOi U aboui too Ui 5 aniJ 
the voriaticn of the Xvo w^MiancrA unJcr dktedc inSucncc i» aimctf 
prnl^l. In drrhnci* nf iht? liver nxnnirrnia ^ itRualljr Incrrawd m alw 
in hyprrchloi^ydria. pylork »tcno^» and acute tMifo-cfikritio. It » 
tlCmbiUhrd lUgblfy upnn a vegetable dkt and Ihe arlmtabliuioa of 
fai ool onl? Lnaauc» it but guuca a corresponding but laUr iucnw In 
iht unnary acetone and Euvb uhne m&y ihonr beU-o^ butyric ami 
iliinlic ncidv The melbodi of olitnatJon are Im conijillcaicd aod ibnf 
OMUMfnlDif for ordinuy dinkaJ uaca ard are therefore onrUcd. 

ALBUMinuitlA.— ^ Xorwud mrhv-doamit fortUin a ntftiml amMimt 
cf 3fnam-*J^Hmin Ur m^^W dt urtatM f/iWodJ ^j^ 1/ tkrit are prop^i^i 
mdde. Tbvrrfore a reictinn tirulrr mth cnndfttom ii paLboIojcir. <.ln 
thf olhcc l^Tiid the fireirnce jj utbumin Jtfa iwl pfWt a «e^uMu aa both 
pus 3.nd bL'-od yield a portiaTi ol their nlbuinln lo the uftoe and any 
hemciirfiji£ti: or Mjppuraliire tevlun within nr enn^otui^iisting with the 
uHnary xnci may <nuAc albumlnwia. AKain, J^ a^tmcc ^t 

~ J 



a givfm iftdmat d«u nnf txtUtie thitmic ^ien^M nephriiis, cu iii 
ibftl 4tanM tbc uriae rooj be albumia Ine for long penccU or npptar 

or pIqoicaL TV mfrt ^rttttim of tiffmrnm t^bui a port 0/ tiu 4iag- 
n$H$ wul 40 fsiinuxk>n of iht loul uriiuuy toUdi nnd um in ihv 74 
hinit> otitic uml frvifurw^ Uy tlir ihIi hiwhjwt |hUy a linger pArl.* 

Albumin in thit cOQCtclion moang^ntm -albumin wlitch tf utu 
aOy UMCiiMri tttlh u-nini gluluilfn vrhkh arUthir Mtnir, han mwriiially 
the MUBf s>gni£cAiiM and ncctl tiot be xpitnitly Irst^d, The urJnory 
mutm mUori rlktufbi reatioiu but muU^-^IhHmiH frpquEndy ohtcurrs 
»<ne o4 ibc more dcUcAtc tcM^. Tbls tLtlMl^cc u nicRAJcd afut 
ovcr<C3Bc9T)Qn, in tdufll inflammation ol tha urinAiy tnct, otpedAlIy 
in t>uiuWiil a^iuiiiuldtMMu. in Luakarnitji, punrlicc aiiO aiulc iufcui^ii^ 
wilh mvioJ toixnua TMt< — JVudlM-^Uvrrriv 10 nadily clcli'dcd Iry 
iliktiB^ Itic uiinp with thnr timr-i iic hulk of witfrr and rnidrrin); il 
tffon^' 4dd vitli acetic add. 

AL8UM0SBS <hMf Ot^ WKOti^aij ippciAi In Ihc urioc and have 
vjcnc dlnical impoilaiiiT bi:<au^ uf ihvh itiiiilon Ic suppur&Ijtr proc- 
mmKh lli*ir pnwnn, J&r cajuraple. ia a picuiiiy would suggfvl 
empynrui; In mt^Hfljiii. n seprlc mhcr ihnn n tutirrnxlmitt pRiccss; 
im a sevcrt imatinaJ laJ^^Q, dytcniery tx tjptioid r&thcr than tubcrtu- 
hw vkerartoft; In brpiic diamf. abacn* or Rip|iunilv« dtdlecyt' 
titiA; in (uftiura. malitnanl ukcialionH TosL^SccctiLlarj dltiULno»ea 
an pn<i|iiiatrd by acetic add uluraTcd with todium chbrid« 
or ihu brarvt ratiHtm mxy be obtaincil oi follows y-Rcmow 
oU nibnwin by trmltatc t^e urine vilh imdi^im occtnlc and 
ibcti with Crrrlc rhloridr nntfl if pnxtnrrA a divfi rrd rnlor. nr(iirHtL»- 
carefuliy wlih indium hydiatc. \toi\ and niicr. rtixat if a ]K>i:iA4ium 
f«rtn-cyanidf tm Af>plkd to (he Quid sbowi ilbunia. Nudfo-oibumin 
and taudn may abv ntvd la be fiivl rrmovcd if prtsttit m quvilily. 
Thifl b nradily accomplitlied by fCmnpiLy acidLdatinpt viU noetic icid 
and fikrring aftrt lacvprsJ hniirt 50 rcr-f *IKiimiii Jnv uHnrnrrihcu 
■dJuJitcd wilh HCl ifi c-rO and phofphotwiptJc t<\d m>I. nddcd unliJ 
CM> fimhrr pnvifiliHif Is ubuinrd, ^ntd^ bMC !« ihm npplEM nn[LI ihc 
pTCcipiuic abrink^ and ooUocta oo Ihe bottom of the rtcq^Udc. After 
drcantifl^ the prcctpJlAie u repca.lcdly ira$hcd, dilute aodium hydrate 

•Oa* ''1 <hp riiRun'vttit kjutt** of tmn »rt*r^ frT>m tunuminttinn ol 
ibe ffiecirnrc ty imcortlcp^ rHirhaigror th? pui ind htoodol un-lkrilfs, i 
k^ CDmcinnly thrre trt HrPuhtM ttpmift^^ dmnEng jihvnwn of tta ws-' 



tcsmcAL DiJLOjrocifr. 

A rlintoi 

I'll rcl Ion >l 

iddci] and the wlution wKtmcd UQlil ihr thxp blue becomes a ligkl 
yellow. After cooting n ddutc tr^uiioii ai ooppcx sitlphMe ii nm drnm 
tbf »fil<- of tlir tntjr nc U'Jikcr and a fMt cokr bdkiies llbiMime^ 

TheBciicc-Joncs*Protcid. Thi^mufonncriyMppoMdlobcuiAl 
r>umo«rbuiUj>>rr ji ihiiSlftil hoi\y Ils|^«flrtincassoro|t«0inAUf{a 
and uullipEc myeloma and con^iilutcA oa« oi the dmktt] oirkdlin 
lu fnoitt chamctcriilic fciture ji its behavior when bc«t m ofiplied 14 
urine cimLunliig it. Comniemlnjc OA (ui npacli^ at 5O* C bcoomei 
pn>(lf;itut(xl M about 58^ Ci und bcicasa up (o 70^C*iri}CR ilbefjlni 
lo <liKiji|«'Qir and il boiling prani has rtfhirn«c! ti> tu flnc opalcBcmni 
WiUwut dbniwirg the lheonr« rvlaiing lo (he c«uMlion or albtuntnuvv 
one iiujr so; that under ccvtim oondiiionft May Of aU ol The piti<«id bcsdm 
found b bloud plasoLa may appcw in the liHn& 

The Sij^lHcfliice of Albut&inudft, — UtWr aptly <DVfft Uw whoir 
field in ^ayjiiv' "ik- pri'»<'ri«- of hlliumln ui ihr ntlne in tti\y fom end 
under am drcunudancee may be rcgnrdcd as indieatii-e of dianga 
in iht rrtial or giomemlar cp^helium. a chnn^, hauvnr. whieh nwy 
be tranucnC* aligbl eod unimportant, depcndin^c upon Uic vanalieas 
ift Iba dtcuUtiua or upon iniuting substnncea ukm wiUt the ^^BH 
or. Icinpitfv3y pnwat.aa in ff brilr ^Luies.' Wc know tlial aJbunun^H 
may Follow emcvJ^rhiJ ^far^iMiTf, riolcni urrdic, cold biitbs> ibv 
ini^irlon of ei«HLve araauntt of nimtjEenouA fcods or Infertiant ol 
vnnouA Linda. In yvunc pcnutta it may be irrcculaily inlcrmiucal 
or Qccut ai rloflnUa IntervaU (cydlcaJ), i^hoLly laclcln^ ihe gpncnl 
and uKubiuiy ^rinptonu of BriiEht'a diatiuc, 

Teftt for Albumin. - As a nsult of an ateoded terife of lata and>r> 
taken by Dr. F- A- Hnff ancl ihc author cflTeitns both minnal end 
ebnonnal i^rmra he la ^nviticod ihiE for the i^enend pradttioocr the 
only lale And rrliaMi^ Tr^tt a/v ttu hnU^tml'iiittit ^vid frcadmn. 
Iba fuai kjt ui/A c^dic add and hrinc. Kirry olbrr leal uacd 
cnqverunenU gave conhiuog rtauiU vi-b«n il bccinie a queaiion of deter- 
m£nirt£ ihc small tnura of albumin ylddb^ a hvc but no dofinUc pn- 
dpiCate, J'hc nilric add layer leal 11 oiao fn^knl and aoeumte if 
prr}tifmM s^A tatu and a prnpn kttim^fdg^. ttf iU duterMi^ faatn. 
Ia diia fonocclion atreivl oih^r teals arc mentioned beooK of ibcir 
pcncfil occipplaim by phyAciaoa but thry are not recommeviilvd. 

OcDeral CDnaidaatioiu.— The c»cntiali of a dinlcAl tat for albu< 
nin arc <0' Simf^Htly. {3). A mttmablfi dt/tt* 9} dtUc4fy, (j). £>«d- 
^"oitss. n^implkity mlucn rarrln« nr imjirrfca wnrk In a Diiaboum: 
ii one ncecdt a loaaonablf dtiuaey he Bnda dialuibbf reftctlonft b 

11Kl9lAtm»— NtTHfC AaD. 


■Imoil vmf uriafc and finaDy, a lot mual tw «> dlorMv ns to nakti 
iiimiMi—li) At mcnc cumptlcatKl trstt foe diiturbing uriniry praCddf i 
uid pomit A poailitv arid convindng opinioii. Tk4 k«ai-<srvi-jii/fU 
Kid Int or unutfy offlUd dots Mf f^ft fkeu rt^ttvtmmis. Merely 

utd precrpittut tb« pbo«phftt«»- Nitric acid «Jon« coagubus Mram- 
aUiunln. the prtaar; ^d ucoDd^ albumosrs, nurJcMlbiunFn >»d 
the roBJt md pn^sutcs unlest if pitooat in cvcao. The cutleos 
•ppUcUim of 1^ h^KT KM (HcQer'K lot) m>y mult in the confuabn 
of ihe low-lyiDc<tr railia. junction ixMol b&nd of fLllmmm willi ihc 
bightfUnlDBi od nudo&^lbjnin or mincer. tiieatbumLn nnf{ nu^bc 
olwoind iu daik o>1on:J uriutit by llic (a^niail Jcvtlo|.cit aX. liic j^jiiil 

U koU Ihe AiAf Anumf Uhf HglH bat sgainit a bUuk badtgrDund SMh 

Tlw Proper Application ol tbo HMt-Kod -nitric Add,— Clear 
the ipcdmcn hj litiratktn *>r \i b«Ucfi«] (p<r4iii<n( cJvudircM b usually 
du« ^ bkctecu) by adding tariij-ti cirboaai«. ahaku;g indtilMring, 

HEAT-AllI>-inTRJC ACID TEST.— If rhr urine be conocn- 
imod,diluie>l wilbCron) Iwo tolhrte timcstUbjllLof water; if oi Iym 
wpeMc ptyitj. add \ (u vnlucnc of A Httiiraifd solatJcn of (»<1bm 
cUondc. HitA U) fill two PttjviAy dear lc«l'Cbbc« 1 lull al tijc Jtinc 
and ta tfntf oiM Cor iidUMiutnl comparuton o( trufpcuvncy. (b), 
£«' liU N^^ >orlH)n of the liquid in the rcnuiining tube and dueitly 
o/l«r boSng add i or a drop* of ttioa^ nitric add nad t or 3 drop» 
more if BO ftrtkuni dnurlltwigi or prrrlpiurlnn sppmnt. (c). Any uirh 
pt nhtaii d pMm ti ct prttipi^alt ia getwn-aliiumtH. Caution- lU not 
§dd ofid hffart hviU^ nor hoil -tft^ ttv aMuit^ o} iht Afid* Rrsint 
>By be pxcseot uJ cwAe opadiy if tuifai*^'- *^^ ^ nndalvood. 
oopuba and the like ore lAktn and bde pigmeai may predpitile in 
Icteric urioCTL but Ixrih itUappcAr tm thaklag up wIlIi aloihoL 

TUB NITRIC ACID CORTACT T£$T (Heller's IcaE)^ l'l<^^ 
in a enn4c ^Us or i«M>Tiit'r a t\ntm «r tvA of purr nitrlr arbl, and. 
nic^^ a ptpCL aJkiv Ihe urine to Bow goitty down the aklc ol ihc 
iadict^il ghdi and trpon Ibe aurfaoe. If tbr muulh of the pipM he 
placed agunit the lUc of the gb»^ jMi o^fft'c ^A< Iciri of die aeid* and 
a Tcfy gentle flov catablithcil* the nmiii ta c^itrcjncly dcan-ciii and 


* The Ulter iBoccdufC ctpcdAlly will ofUn ceiac llv eoEiTrntoa af 
ajpoUBlA cf aloVAin in^ awidabk *ti6 tlburaoi u it rradily proves ^^BF' 




bMUtjfkil. Aibumin, ij pmfnt. cpptUft «i d Haihi tr rtnf[ aiikt itmt~ 
Hm of ihe two fiuids Anit is tnon or \m Jiitincl In |itjpoctfa» lo dw 
unount «f nniumin pits^nt. Tbo tub« or ^aH»ehcul(llK]w(«i<le» 

bevdvl minula rnj.y be required to develop the nftCliOL t/m^ry tol' 
tftin^ miiUiyi ^ftftcur nmr SJte >u/iat-< i^ Ikt add, ktU UtmoUy al a psinl 
ju^i brif^^ tht aibunttn ntt^, il the IcaI hu been propcrlt nudc:. i/ 
yrilkin (en piinuUi ihat ofjrtan unvther nif raembHiti u t bwm i m^ kmt lU 
adistmcUy hixk^lfiHi fftu may aavtfU that a kMv* fxttu *] 90U 4^ 
or acid waUs it pftutU. or. thai JA« tnin'tdi«af )rom ypkcm tkt wimt «*« 

AfiifiiT. if praeni in fxtm, mxy tarm k hf^l cLiud in the upper prviioo 
g| the mint:. Bud rtiira may alni be proipiuicd but &rc Liuj^n hy xhas 
inunediatv JiaappMiasce wban a pottioa of tli« doadty uhn« b vMi- 
dnvm by tncatm of a pi|irt anil Eilialcm vrith alixilioi If epaoe pn- 
ittUtcd.mudi that bot intcrut might be aojd cpf the uncftjy chnMDopfB 
jtnd jMffmmU, If nne wUliei 10 siurty ibem (he urine thould be pUcrd 
ia (he kI*w «i^il a <ijnv<lcr«,hlc C|uantJty u( the add poured mlwt 
briakl^ iji^^n th? f^uk, Wlien thU ia ilonc, tbo coloring mt-itan an 
piominenily du;>IjLjYil md ili« dl]miii4i lin^, if pnxoL u nwd loa 
level tEmt nearly oorrcspoDcb lo that of uric add lad add uimtea, when 
[hf tm \n ipTdfrd by the And method, 

^PfHtfi lirf t:x*.-r\\t^nX and qull« ruflidrnt for urdinajy purpo«a^ 
0/ £Ae j^tvt tht fH'tt-<irui'nMc <tcid Uji ij flu ncrre dt^niJt imd 
pefsUhv. Oh li\t ether kan4.the totaUtd "htfal-ami'mtrit 4tid tttt' 
at gmnaUy uffd ix fi^Uibht ami miilfj^iiin^. Ti »tll he 
that tWiA incthml <x-^nsi«ici in addiii^ nitrtc ^id, drop 
ilthiU bintinj^ Ihji unw, Thf f^kiv-ing rfron nuy ihrn (xmpr"J 
tttkttl jnti'HHf c/ fj/^Nmr/i tttiiUd arffffa 0« 49K«U tfj crd^ m-ty /cm d n^ 
6/tf <xHd albrirnin xind rt(apt dtlttlicm,m to otber hand, iif an dUirfiM 
nr Htutrd *r>Fic wiik fko^phata ffomi in €3Baas. a }aiiurt h oaSfy 
fMt jpecimfn may ruuit m tJv jormatitm ef a tvUAU alhiAi iS^miulf 
juid nMur add ntrf tJkdii yilhu^naSrJ^ art pmifUtitd by sutu^uaU 
bnUnx. Furthennorc. a<oordtn;y; to Pwdy, muiin. iJobnllQ oAd 
^bmnowi art prcdpiuiul by Ihii m^lbod- The nuihor rficvAlly n« 

*Aco3rdlng ii> C fC- Sitnoa the fuboequcat appnnuicf of afiUn-Uke 
hntr frridit on ihr tidn ot the g]ke« imdkiin ihAt sliout 15 ta. of um «re 
coDtAlnfd ui 1 Liu< jf ihr urine under eiuuii[£iaiiou, SuaiUrij sputftlaof 
ihi* lim nkidte tAuit t'>4< Km-.&mi. Ihc trpuAtioncf ft dciue tautf la JO 
or mon ^iiu< (0 tJielifrr. It mvtt ho rcmTinbrnd t3ut nidi doductiaffB «« 
aot «f much veliM ujit?« the •pectmeii be a pan of Itv e* boma uriaa. 


rurUL?SlS-"ACST1C AClft- 



In wtrEcb a R|)ixiint-n of uHnc cnatslnlrig c.2$% ttt albuotin «u 
repMled narm&l aft^r ib^ applicalioa of tbia le^t. 

-^T«J A pu^tjn of ibc urine aubmiclcd (or cxaminaliciu Ibat wIU Ivo' 
thtr«i« fall two te«C<tab<9i kAd t«io of \httc {nevei manl dropa oJ 

tbr («t ftH*J a^whOdy <kat. A ftinj^ fiJlmtion uaimltr atif^ci^; if not. 
ibc doudiooa ii prubifaly ^ae ro bidrriu, wliich piuM mi[liL5 ihroagh 
ocdiiAiy GfTer r«P^- They ODfty be ca^>' removed br adding IfAnum 
cubooate. shtkiajc. and filtering. TtUrd^— Sn jutde ft portion of ibe 
pfevt»asl]r Kii^licd ftknd urine L^t cumptjiton. Fcwftb^^Acll ii} 
tk* rva9*iniiL^ urine ocw^ixih of lU voltjnw ol a ttinrxcfl aqueous 
aolutuii of cumEiiDtE ull d.Dil 6U a toil-lubi! Iwo'lhinls fuH- 
Piftii.— Bo£l the upper portion tborouf^y vkd conpue wilt the 
ttnhnirtl ipedmen, Inlding boih lo ihf U^ Rjiimt a block hnrk- 
fTound. a* prcviounly Ptcommcndod- Any pna^U.te or doudlacH 
ki doe to •crvm^ilbumiji^ 'Vhe amount of time onUnull^ laTotwd 
ia trifiing, acd ihcica b cxlremely drfbile and dclkalc 

The (ml]r no^ieaid rr^uircij are: {a) antic add (50 per cent); {b) a Bcnid 
laiuraied aDlottan of amiraon nlr but Iht fwxdim MWif bt tarrird 
otd in Af exatl «rd«r hen ftovn. 

Tli« Potoaidiam ParrocyanidaTafl.—CntoaHcanim-iLiliepottra 
draiD or \nv of aalJc a^id is^c). lu diU uiJd tirkc iu vuluiuc uf an 
aqueow solution of potmium ferrocjanidc (1: ao). Shake the mixture. 
■Qd avnlax «ilb Uic EOipecind urinr, na it done In tbr tiitrit vhl 
coAlmdleaL AHxiinuxii procnt. appcara at oikc Biabondat (he junc- 
tSnn of the nro dnlfk. TJb /mU im/iunf 1/ lu/l^ t^dti MMif ht /vldrd * 

BUl|Aat», $ paiU) ma<r b« uifd u in Heller'i lest but ik il arvilnug loo 
debate d.nd subjcd to tbe torn:; ctrmeiilaof emit, SpiegleiS Teat.— 
U too drli^ie for dbucal wotk showjageae pan oi ilbuinin in 350,000 
nf urtee ninioinlnf^ abunduil i:hb>r1dn. The tri-ch]or>cvlic acfd 
t«*t can be maHc by drofifiinx a cryvlal En|f> the uiiae eontaincd in a 
unall Ipsi tube Itbntrenvtydebcate, pofilally prrdpitftmalbUTru^f 
and. in oooceotnted urinc& vratca oa a diUioci upper ricg, Thtac 
tJirefl M^ ibovr albmin in all unnea. or «> iwaxlf ao. aa to rob the 
ruMflng od a tna of il^ clinlol iigntficancct 

^DiMtkHi9iaf€M. U pwdpflau* aJbuninia ind nucfra nlbuoLin. 
fHefrn helnw thr auttw huiArlilorii fi»i\\(\ x diilimi ring wiili tii-<ftkf^ 
aenk acM vlihout CDnflnnatary ml(r»«j[tlc iirnha^. 



i(k»ic:ai- rtAnKTHK. 





suflirrrnrihrrqimniitnitiY ntimfiiion of AlboraJQ. Th« Ani dctnAMk t^ 
\ac of EjAoc^'j itffruimJAdM'Jirf . liic Kcond rtquErea 4 ttntrifnft. Dodi 
lesu trc extremely umple in cxeciJlton anfl uno |ih]rvidaB'B<il5ce is com- 
|ilctc wiliwut a Lcnlrifujct and us Lbc Esbdch ivlir ii Eantfimilfe Nad 
cnUj ebtntaiAd, n^ hinlship lb lutoIwJ in their appUc«ii«i. Eibuh'* 

bdov. TMi lube b filled to the letter V Hiih ttrinr. if oneaavr 

pmrioLitly dilLiicvl until lu Kpcci^c jcnivlty U 

lOoS or li>nTr. &nil a solution of pkrit; adil 

(picric Kid, to; LTptallint citric ad^i »; 

ilbtillE!^ wicri, locxi) u ^ddctl unltl ihe 

Urvtl of Ite liquid Juli reoclied (he IcWcf 

R- A ful^hcr flop^wT U thm lawrwd. 

the tube i« bvtrtcd aevcrmi limca (c tlicr- 

ou^ly mix ihe iirfn« aod tcM Mlulion and 

i» IhcEi Kl SAide h>r fnmi 24 to 48 liouia. 

ITic ilbumin ii precipiUlcii and iUi hei>;hl, 

mrftnuTTfl hy Ihe numeniU upt>n the vnlr. 

tcpitaeau in ,p)c. th« amount of albumiii 

pravmt fai ow Hire (1000 c,r.) of ifi« urinf . 

aiuimte for pnctkal puriKiKs UEihGugb pcpiciivak naudna. etc. If 

pmcntn an pKd|»lakcj ta^lher wiih the Ubumin^, bui 1atf«w. and 

far Inferior to PurdyS dtrm reniHfngal nieUiod^ 

Caatrifvfal MMbod.— Fill Ul« jcnti^uaicd tube EuppJird with thr 
CTfiirf fu^ to ihr mark 10 t^c. Add 3 r.r. nf a lo^ BolutKin of pntatfiian 
fcrrocyanidc and a ccof «ccElc add{(o^). MU Uiotouj^Ij.kI aalde 
forlm minu1f«. and, IjEt^ou^A/^ rncif^if im tht <t9drifHgjH unUl liu t^ftf' 
mtiiami fittid M drar amt Ok aHumin rta^y tUpoHkd at the bottom of 
(Ilc tube. Each mark rtprr«cnU i^ cc. and convapoadft lo a bait 
mcsaurr; of 1% or ^ of 1% by wc^hl (Od|Ecn) * The old fashoone^ 
fnctbcKis of c«rtirution by boilioi; tbc urine in a lesi-tubc, or br 
judg^rg the amootit by ih^drplhof Xhfi ring prndiired by th* ronlact 
lot vilh Eiitnc add arc useful, but not sujfidcntir accurate utA 
iniroducc too mucb of the pcrtonai equation. On lh» oihrr hand. Ibr 
v«fy ciact nicUwda of ihv chcmkal Uxncory are laborious and 
ilamand mote time tban th« busy pra^llonar caA ipve. The (aUow- 

* If w*l<* *Tt pn^ml in rucm th« •uix-mtlunt fluid may be inlAcnl hf 
boiUns water ahrt «nli9iigd£ultoii «ad ihf yitoccM oooiiaiMd a iWvi 
time longer. 

Ttiii mrlhnd b mflkknilf 



uioB if caapbttd Sy E. S. Wood ond 0«to lor roo^ | 
vork and b bmtd upon Ibe crdit rritiic tM tern pcrfbnned u fd- ' 
\oyn: Aa lUiliiarT wiocr ^ub i» half fiUcd xtth urine. tiKlincd unlil 
ihv Ikiutd nnrijr ovnAcnrt and then uvdrrlAkl viih nitric dciiJ. pounnd , 
in aa iii>wl7 ai posibk, until It d^uAb onc'third of the Liricc Tol- 
tine. U Ibcn ibe wine j^bai be perfectly dean and |dscei^ obliquely in ' 
frcHM o4 a <Eiirk btckgniunil tbc r^Mrnrr facing thr light, Uht>' (11s- 
Ungubh (0 ibe ccU enpl&nitoiy "/ifiilMl pmtittt frott.** (a), A vtry 
aligkt tr*4f. it. a faJnl doud 011I7 dffinildy wm against Ihif (lark ba<k- . 
I^rwicil, tXi 9 Ine9, vaibk mihoui biiickgr:>un<l, both fmtn ihf side and 
Cpdri abiyr« but not ciciiict«]ia| the bottom oj the gUia when to virvred, 
(4) ^ Wfi? AnkA I,t. • chaiplr ^dlacd ton*: but ii<jt d^KuUnE nor I 
wlkotlj ofoque irhea i-irwrri from above. (Kaprcatnta about i^ioof 
1%') (5) >l ) W ""« ^ ''^ nnution* tc, a aliarp non-flocrulmt umt 
obtfcimas the botlam of tte gUvk <6) J of 1%. band fiocculcal and , 
opaque, (7I \ at 1%^ band dtn*r and floccuUnt* | 

PUS.— PiM in the tirinc b readily rscoptiacd by chcmic or men' \ 
tt9pit Mtfa (m« |iag< 34ft). Aa a graai aadimant phfitfk^ttt and the 
■rnAn niaj nudlrad lt« cvrisa cibsuircr. but «houid never cause 
Urates are dUedvrd by beatinjiE, Phosphates dLuppear 
btf addd whrffvu boih the foreRohig prooedare* will incrrnse 
a turbldiiy due to pua. Cti«nic Test. --Add Uquor potaAuc to the 
ausfwcteil vrine inr^ nh.ikr thi' tfili^rlnn vi^i)n>i):i1y. Tbr prTtiaurtec □( 
ausfieirdcd air-bubblea and ii»iijily LcdiLdLc piu. If liic amount 
be vny large, or if the Liquid polaoie be afUlcd ta the atvlimmt aitar 
dcowlinK ibe iu|]rmjitADt (luidn n grUtinoUK nuuiEisulU- Thcmitm' 
aecfiic test i> roare deinJlc nKcn mere trocca of pu« ore preacni (aee 
pa^ 34^)' I'bc addttVm al si dm^ nf tvry tW«j/« arriir add so- 
lulioo 10 a mic^MMuidi: prapamtiuii <Lratly brings out ibc uuclvi of 
put cella mtcfar Vht microecope. 

K«OOD (hmuturia. hieiiiogLobmuria)-^The color of uiine con- 
lBin»K blao4 in quantity hju already been described. In gmend it 
tmy be mid th>i odd orlne* amtnlidng amrid^ahie tilrxxt are dark 
or anoky, tnd alhalicc uiiaea br^t red. OIU&ltmc» El* peeaencc 
IMS br dftr^c^d ev«n tho«|h ihe amount b fnaufTicfeni (0 color ihr iirlrr, 
and mccecwi mere txAor cannot be depended upon tn any caacL For 
tbr detection of amall quantitioi ihe tnicroscopic exominatbn, chemJraf 

^ It wUk be >fca Ibet »ttch diiliDcdE^ae require muc:b prarticc but Itrun 
pcVKNUl cxitcnRnee la the Ituiard UliDirab^ry the. -imb^r con attest the 
aceuity thm altftiivd. 








juid thf cpcctrofttti{v fttv cxinmiely imparuurl w the coloring 
tDSllcf flli>nc iKuty be prcaenl primuilj or bA the nstJl of £rrtaenUtioii 
rh^ngp*. Thr ct^tnr diie to pi^ftvnirig by txak mr prDdnett dosrlf 
suniuidk'H iLe imi>V> uiint nf li^tniaLurLi 

U«U«r'« T««1 tor Blood.-^a^ Boil \be urine b » Mit-tvbcL [b^. 
Add cbundc vofla nnil cnniUiuc thr boQJng u long » pRdpiUinn 
OMilinucj. J) Mood he ^€iertl. iJtf ph^phalk frtdpitafe u Umtmisk'fH 
and tkf fupfTttnUiift jttaJ, a tttUlz-fir/f*. I'hlg I«l W nid Id dtttct V 
IMil (if b]L>^>ii to looo pftrta of urinc-* 

Ib« Cuaiacum TMt for Blood.-5tiAk« in t tni-iab« equal ptrU 
of dd turpFnliDc (or hy^nkem ivficiuclc vatuun) And fnak tiaciuK uf 
Kuciiacxm. pQur thb nvixturv jEcnily down ol^njc tbc (^dc of tbc tube 
u> u til ovrrfAy Thr urlnr If UrMif or pvi he jirrsmt n t^uc hand 
Jippenfs «t thu ixjini of fundion. li ihU be due Bolelv to blood, it 
pvniatA vh^ \ht l?m|WTatiire ol the mixtuiv ii nbhl to th« bgilinf- 
pointi whcreu» if pu» alone be parsmt, dw eokir disappnrs^ Aa ofU»- 
iim«» both ATT fxTHf at m (he urine, the rcaclioa ciuy bck pnejnaii.f 

The Sources of H^mnrrliAge. Ai^iiir friim .iriiEc Brigbi's 
«r ttcvrrc oailc congtstion the conomoiKSt oourco) of blood m 
caloili aniJ new gmwihs. Cloti occoiksnally exut if ibe Mood is 
the bladder, or tmaHl dots nuy represent ihc lumen of ibc ureien- 
Blood from tfae >idfl^ is usujdly wtU di]4lT»t>uted mad tadu eloti; ■»! 
Turllwr indlcniioiti of lis wurvr ttrv fituml in the pftMttOc of 
ciaU ind fibrinous cula. If from the fcii/Hry ^<h>*>. Lbe Wood 
Lhuroughly distribuUd and ftiBx:i;iied triih tbt [tM-dlinf qitlhc 
Jul R^n. It may be due to calculi* acute inflammalion drrukBO- 
Ltia. and tuocuiCMl pufl poinF£ to uidAinmaiioa whetlicr siinple, veptic 
ur lubcrculuuA, £ffiE^^<r Lici3JoriliB|^ vujtgnt ulc^r^tj-io. <alcidi. 
liunom or ftcut« intUunnution aaci, iu«ly, nuL pacwiMc i« the } ilana 
Mfij^nta hominu aiiy hv found with ■ dtyluni. If tirtm the urrtAf* 
Jw fint jet of urine comialru i!l< blood or pwi. tboujtb if from the prM^ 
lalk ]ioninn k may appear diirfiv ai the end of miciufiltoo- Acri' 
JenUd bt'tod may occuf capcdally in Uie female Mid tniui be cjtdudrd, 
la hsmoglobLnurta t^r nicihemoglobinuriA Ihe blood c«31a are aunt 
or abirni ami iIk: 3pe<:tiuHiujjt; &hov» tbc dmrndcrivdc baud* of ov 
taamoglolMn, rvduced hrmof»Iobia or mcAlieiDo^bin- This oondilioa 

*If i1]« isrin* be nllulinB aad iti pbosphoM pnclpiutcd one may add 
■one acid normal urine bcfoie twiing, 

t If Iha ilif hint trace of coppw r*QEiin« from HaiD#«* or FtMing't Inl 
in an imprrffcily eleantd tube ■ false nacUoa wtU flppi!*r^ 

nmtAi.TM»— wui— cLocoat 


ocom ID pDtKmio^ by nJtro-bcoBol. aulpluinAl, uili^yiiii, ]jl;cn«cctiur' 
oapfclhoL vnuhroomi. in wven ODpicil fn&lani, aiiiI ctrtun cilsa of 

BEL£. Bile odds utd bile pif^mont vt boih found in the unnc 
undfT mulfi (nni^flfiDt. SUe figmaiK IS prment in rant>\tipnh\f 
mmMkj IS Rftdiljr ddccutl hf ih« ycllov'iintcd htm pioduccd bj 
tliakin^ Tkt htst Hmptt €fi*fme Uft ^Mhii^ar/iil/inr^'— filter thewu' 
pntcd urtnc >naad tima UJixtu^'L the aanic GIlci japcr. Drop /uninj 
nJcric aod up«ti Ihe wet ptper and witcb for the <hancEvri«lic oolor 
plajr. vt£, oniA^ m!, F^det and grmi. ihc^ buit bdn^ thr omniUl i 
coUr. Rhoffibic cry»ial« of bilirubin atc readily oblnlntd hy ^}lMng 
up AonMlMy wiih rhlorofhrm. dcrRntknjr nnii Pb'jifvmilng ihr fhliirn- 
lona axntl Harech&ll'f Test' OvrrfMV a portion of Ehc suapecicd 
arise in b lAttube inlh na alcobolic tulutioi) i>i ifxliti (lincCiffv lodin, 
to pwu; okcSiol go pnra). U tnle be pocvni. m bcnutifu] jcrccn bnnii 
appctn ^ the juEKthon point, 

Bfl^crflft^c Tt4t for BJU Adik.— U mAik bv dmpphg n 
pjncb cJ "ficmr oi sulphuc*' i.ipDD the surface of th<r suapccitd uilnc?; 
U the fiiY# ortfj m prwnl th« povrdrr ilTC|a ro Ih? borir^m of ihe tube. 
Tbit M lc*i hn been rcocntlj Mudicd bf FisnluL and Qumi. Th«]r 
find it Accvtlfv ccciriliiV' and ojt appEkd to lh« urin«, very dcftnilc * 
The nmttk^ti <fqi4tid« ujvin ihe diMiuibancc of turfntv trnAuin xjn\ iht 
pfoeocc oi bih.' idds indicatn tl>c pr«Mnc«of bcpatogetMuajitundicv. 
thoti^ thrir atifmcv ^Pnn nor nclud^ ir 

TESTS FOR GLUCOSE !N URUIB,— AS dmic^J Ic$(b for gluciMc 
in tolutiofi depend upon the foUoving prop^Ttkc?— (ay 7A« fa^t that 
ttkem KmifAJ Mj am^t triih tcr^n vxnit, ru lor rJkumpte. ik<i»r of 
copper and bUmidM, ti hi€^mtj ^;riitafJ at iktir expt^t, i,<-,, Hfi« xi u 
reduHo^ HFnt- (b). tU pftufy jfrmmltifnliiy. {r). Th€ jaiU thai U ij 
db(f^«inji«lffv. (Sec tht> p. 337. LnctOAC. pisMoac, tie) 

The Copper Te«»,— The veU-knovn Tr^mttfr's e^trhaxbwn faifier- 

I crdcil by bvtier arid mofc iccuntc mclhodj, but Fekting'j wlatkin iih 
«a vyidy cs#d u to n<{uirv 1 dttCfiption ttf the icAt. Uttt iduUtm 
U diiiiniUy %nf<rm fa Hainci' nvdlfUaiiiM atni u w un-yUilte ih*i4 il 

I miUi b« ktpi m fWo parU 6md nuctd vktntV^ Wt/Ud f^r hu. 

i FehUng'a TmL— iMnviwifj. (a), ifnnmv aihtmin hy hoUhtR tnd 


* Trarn pRtLcuJ cxpcrlEMc vlih « large owober of " ooknovM " a ccr* 
nmibef iif whkb OMitolnril bPr. Ok aoibur I* uinviiicrd that lliit it a 

^ aDCh] 


WEDlCAt DlAGMfMlfl, 

Tew Hind, 

ItftI iiluc. 



»! tkt foUmrittK liock st^uiions, which when mixed sixiuld fona A ietf 

Solution A. — DtMoTvr 5464 pti. uf purv. dry, ponHJrtvd co|:iptrsul- 
phaie i;i jooc.c- of w«nn distilkJ nul^r and adJ rlisciilcd walCT lo male 
joo ex, oi the ^ijffcl Nm 5(iiuSioH. Solution B.— Liiiaoh* m 300 C-C 
of hut waU( idL> Km. of Ro^Kcllc wh. Filler Add of pure c«M«c 
>oda, 70 Knii Cw>1i &nd uld dUnllcd water cnongh to mik^ 500 ex. 
of a fMtjrUM sduUnn Ktrp in & darlc |ilac«. 

Ifcal i(3t soluiion lo boiling point, adrl at <ticc ao-j^ dropaof the 
im;prrlc(] unite incl ftoiJ no Umf^er. h\\\ in ll>c Alinrncvof a rractiaatrt 
i^c for fnun 5-30 minuic*« dtid try ihc polahscopic ocd fcrmecUEkB 
Uftta, ft ]>ocltive fci^ion ^<fvri nothing buc the prvMiKc of » ivdudof 
afCEDl unless tlic uUim^ilc imxijiil^Lc i» nd. i»il ydluw ov pvoD' ^ 

Ot)j«ciioa£ to l-'tbliog's Soluttoa-— hVh) mg'v soluiion w ordii^^H 
pn:p(Lr«rl iH opm to vrit^ui (itiji^lkii;^: — {^). It iv umxablb (It^^^^ 
, excen of gJucox obKurci ihr Icmnianl reaction hj becoming cuunc- 
ilxod a hoLling bt prolongnl- (c). Il ointioi be dinrcity jqiplied M 
amoioniftcal tirine u»Lc«» wch be ojicviAUy jirep*ivd. (d)- A Uipv 
■nunbor oE flttbtfanoM m^j rvtlucv ilBcupncond. Such arr ^jrturcm 
■nd ^jrcDsuiic add, ilkaptuc, cmiiiiun. tiric add, and vmriDUi dngi 
»ii(A nfl bcDJDoic odd, chlnroEotm, dilond, glycerin* the HKcrfatc*. 
turpentine, ptc- Hmre. If one usM fth\kQ^t> mJutkin for ffU«lltillT« 
work. HcmuBl bear b mind. Ihftl it broore ftloAblcunofisiti'rt Ifaan 
U a [iwiti^Y iT«t^ X Hn>w that dett mot rtdua PMimfi cdMliM il 
frt€ Vum fincosF. hud niiM€iwK doet mt amchw^Miy alMitk iti prtttmu. 

MMiatt* SoivtiOD-— A mudi ^implrr tin'] abtoluldy pctnuncvt 
Clipper luluiKin b ihnt of Hninis-* Appliuicioii of Texi.^lkill a 
(cvt c,c. of the Mluiion fccntly in a tc>( lul^r, tdd i^udAtim 6 S diofa uf 
thr urine, firifl ftcTiv /"f J mow/ftr oni;r TTir rrjirtliw) In IHrniinl wilb 
thai of FdilJriK « mlutioEL 

AUen't T«it.— ^Thii b taid by Hulchuon 4nr| Hainy to have ibe 
fcdlovuiB Adwitogu ;—(&}. AJbur^ia ntcd not be mnored, ^V 
Uric odd. creotinin, and like mbdUuiccs do not oflect lh< reacUofL 

The iphi irrhrs fu vxUxe from ihe fiui ihsr arid NOliillons of MMftua 
dtctalc pKciiiitnlc ihe tnCrTfcrmg subotuiccv without imovinf or 
Rfff<ting any t^»iXMF tht\ riHy bf pttmbl 
' Toit, — la a ptrfecdf dc«ii lesl'lnbe heat 6 ex. of urine to the balBof 

*Fonmuli' Takr of f tin* oopprr lulphale y> gnlQit ^iirlElnl witrr I 
<nimT^ Mftkf ■ prTftd (cUiIJuii nod 4itrl of puir flycninr | omm. bU 

trKDrACv«E^*n:unrKTArtOH te*t. 


point. Fay ihi ftltenCMm to mj prcapitAlc (ftlhuxnta). Add 5 c^ 
of Ibc icilDlion di oopper iiilphnrc uu-d in niakinx rchllrt^t salDdaci 
(bcJuIwc A- aA (tcscT^bcii). Cml partly. A^IJ a c,c. uf A atluEttoil 
•oMiMt tif BodLum acetate that bu bf«ii nndcnxl faintly tcitt by ukSc 
idcl. Inlcifisrffig yul»un(-a att now prcdpira(?ii. Filcrr ai^U aJiI: 
Eo tbc dotr ffllnuv, 5 cc of the voluiioa B uk4 in niAkiag Fehl- 
iejl'* nldkft, Bool twrttlf «floonfk II tujt»r ii pmeni. The tolution 
bccMRO ofttqiK «i>d iptcn, 4ad dcpoiJu, cither iaitncdjftlcly or tftcr 
tf»n< 1 fpg * fevr mimitM, ft Jfiw ;|icUott> prf<ipUatf. l^be ucfs aLlrmdy 
givrn arc pUccd in ihc iUtveI ot6ti oJ tbdr oodvcuwuce tod ii|ndi(j« 
bm the invtiN ordtf of ocoiTKy^ Vet «VTor viU wJdoni occur if n«ry 
ragir imtiDa be dwcicd by the one jucunic lot for j^uoow; tuunely: 
THE FERHEfTTATlOA TEST. T)ua Xcttl depends upoD tht 
txci thfti ]c-weu h A Jffim^itibU sutstaa^f, and ffHitkaUy ih* only fittr 

Th» T«t1.— Th« ittcwl convenient ippiU^iLiu it thit of Einhomt 
EtuM lUf HI ikt pFMta ikiftJd he chnU^ by ccmpiirison tnlh <j momai 

SHPW/ IhcrcfAK two tubcA ore required. If 
Kinlwm"* wicrbAromcier k not tn br ha<1, Jhr 
Domnuauromel«rtub<0willttnJWTr the purpose 
(*). Bt«7 th^ ^KM j/wi'mifti? ^rtr artvro/ mittiifi. Eo 
^Ih^c o9 any oil Lhry may ocoiliun. (b). Add k> 
g44M a ^HuA of tarturU acid in 7rd<f Utn^in- 
frjDV Ihtif atidity jtnd pit^iTil mrimnn Im. a! de* 
con>pa«it{i>ii. [c], DmaoItc in each the Mmt 
amount of Carman yfiiiE <flboiii one^rth of a 
p — — fnrfi ycftst cake u Mjffidcot), U there be any 

W ^*' *i~^''***™'" doubt M lo the frt^hneac of Iht ytut. it ii wcU 

I *" rwft'wf- ^ ^^ ^ ^j^^ ^ Ktlulkm of glucoae. The long 

I IbdI) of the fenncntaiJoo tvht of the aaicchoroincicr or of the Doitmut 
I DioaMtrr k filled villi uiSiu; anil ihe two spedmcna an i^aced side 
by dtk in a trann pUc& About 74 houn aic m^uirod for complete 
ienncfilatkjQ aod quantitalm eslinutinn. but Ihe dtignmut can often be 
imdc in a nrf abort lime* u the appciuance of any ooniidcrabic oniouni , 
ol |*u prona iJie fjieemce 0I j[]ucosc- if^ i»rM£ finjjfvw'j ir/cfAtfAM- 1 
«i«r fJU tnwmitt c} tmg^ mt^y &r jUimnintd ut'i/i dinUid tuiuriCf fry ' 

RQU£lwr Bfotbod.— 'I-nckiDg ary funn of ftirnnitaljuTi lube, the 
tevi may be made by taking the »pcdfic gravity of Iwo ^podEoens. to 
Otte ol wUch |tut it added, and both then are vrt cinde uv ^ \qqw^ 





mmcAi T>tAO»oa[S. 



■xoppfrad IkidG or botiJe ind In • wvia pLaor. U gltKoie be pfttcvt 
fcitncnUitLoci fitoiis llic specific gmi-ily b kiwen^d ajid each degree <rf 
density U»\] rouffhiy ^rrcfipoadi to occ gnio of gLucose to ih« ovnc* 
of urini><n-3i fcm-lo toorr.), Tksspcdfc gntUy tkouUt *h< A«laim 
fA« a«find time unUJ ihe unite ftfu aroled Ic tht Semptraiure is k^ tekut 

to the previously dcftcribed u*U may bv racJilioDfd th>l o| WhiliMy, 

which Is iDore TVfAA diRn the tfeimcntaliim laX. but nty inocointe 
I and (Icpmde upon the dccoloriulion of on nmmonii^cupiiic-Mlpiuie 
I lolutlon 

I TMt.— 'One 6nra a heAlcd to boiling poiot &nd (be urine ib addcid 
I drop by drop« the muciorc bvtng boUrd for trom Ihrre to fivf wcocidi 

tflcr c«ch kddiibn. It ni:> change occun. the proccn is cotuinued 
I ten or flJteec drop* have been added If «uj^ be pnaeal, 1^ 
I color beglnfl to fade, and b fintllj enilrHy rcmov^. tc&vlnfE m coTi 

nlution. The amount of sugar pment ia then n>linijil«j b)' lh« folbw 

ing 1ablc>— 

<oim1i . 

tufrta I 

U fedufcd by Uinlooi* IicooIaim 1o the Ounce. rocvntacc 
I » 10 « more grilm » 3-33 



6 ** 

^- - - 

8 — . 


B train* 





.,^.,» a$j 



.— --**■ 

.""-" »J7 

If Ibc vnounl «f fU|^ b« )tt^ U fa dl oKlft by* A* Icfli <ff color 

fcJIoving (he ailEliTion of oDC drop> thr urine ihould be diluted by dotib- 
Uri% or lirbling ii5 volume b^ the ndJiiion of disdlkd ««(Cf. and the 
nsolt then oblaiaed must be multiplied by two or three aa the cwk 
may be 

tnci than rhiec ^rcuiitlf . In tTic auiho/i hafids U haa pnH-m far mfrtkir 
I0 the fctiDtrnliLlioin ic9t- 

Tbc Potarimet^-— B!rect eaiimaiian of the vugnn br tbb iBcana 
« by i*M ihc most Mibf^torf method, n^ulrcs no apccUl U^Udc \m 

uniffjitn»*-<txvtitoat— tvurrou 





ktfinmcRt b somcvitflrt «xp«ujvc The pcrccnU^ of au^sr la 
mvl dkfdtj &cni tlw vemkr cole in Uie clinical innnimratA such u 
tnumuii/i trat it fii mtulljr ftrxi to dacDloriir thr iprdmcn wiUi \tnil T«chniiiut. 
uetale aobMion; ibe uaIm muaC be tlbumin bcc and the ciontJUiunK 
t»b« df^ or if cmt&lnJnj; w«t/T, tr shotiM h'* rinivMl out with mtrir. nf , 
the aria* to be k«(ctL I 

LEVULOSfi. — L«vuJMr n Bbuiiduil in rip« truiu a^d honey, t*ab' i 
Qurbrxt uncWgnJ and i^rASoaally ippcmn In ihe urine, jet h tan be 
iskcc in quosiity in diAbctci vitlicrut CAUiinn ei mcirlteij excrtuon ood 
in cffdiA^ icfyciKuria mxy ntpUrc nuie nugiu' oi ^ucow In the diet, i 
loatescift ol pure Ic^uIok diobda h«vc been reponed but tbcy %rt 
ruwdhagtj rare. If ifv) gnu. of bon«y b« T^hen on a ruttni* ftiAnurh 
bj ft Q«i-d£ib4tjc rol more Ihui id e« 15% ivill ahow Icvuleouru but 
id iiM*»t «l At thYT nidt M <ifThonS^4vtmffma and rypkiiis the Mriu 
UU fttatiu m a mdribJ uvntfiim 4wi inffroJ Me siabtkmu may appear 
spmtammuiy m tutk casts. TetL— The ucxhAromdcr (poUmnetcr) 
■hmild thtnt nrtntton 1o the led, but iMn svlstuu^ rniUs to jtrtumiti- 
U^n amd FtMi^e't n^tUi^H exactly like glueeioc- For icIcnli^caCipn 
thertTiH* ont miat luc S«liiruiofl's T«ft. — Add to 10 e.c of urine 
(aibawiDg tEVO-ioUliaa) a IJitlc rcsordr uid 1 ex. of dilute IIG; c 
hngM re^ fMcHoH tppcftt« cm hcnUnn ii lewloM be pre«ejDL 

LACtOSE Kp}>rjn In the urinr of nfomen ntxtt cUMUhiK fiot b , 
pnpiasQ- tail tnon frt<queDtJy in tbone who do not DurM the child 
<ac^ M ag^sni stf^-'f.). It a mut ahutiduil aboul llie Sfih tnontli 
ftber ddjirtfy vid arldom cccecib 0.5%. T«st. — /f fcAicn Fthiift^s 
aeUaiam «nd i* fcnaeatabte wilh diilcuHy bit! vhenevcr »ny tugtr re- 
mctioa «1ifAU» In woOKn aficf (Irli^Tfy Hubner'9 Test ihould be 
»ppliecb— To 10 cc d uriit« nn tddvd ^ psa. ol Ind ic«Ute, ih« n- 
vuUnit turdpjuie b filttnd off mad die £]inie liealrd iini[1 [t tmumes 
A btemvilh color, «nd ocDio ftfte* the addition oi tanmonia. Th« 
nppeiAAC* of n £nrl pvrf rdlor attd a tkfrry red pr/eipiiaU inditaies 
Jm^m if there be more ihnn 0.^%^ Speclnnenfl at high A|>f\itk guiity 
«JioiiliJ be diluted anp-Kalf and Uafl unounU nqum cvnpomtion of 
llie untte an^ ■ irtX oi ihc lesi^ue, 

PEHT06E. — Aher lb« ingesiipon «1 inrge qiaintitiee of fniit, or mor« 
nrdy alter t^i»X ncenne imoanu of vegelobleaiv oofTee. ten or mine. 
peAldSe M*y 9pp<mr in smfidtrU amotml lo rtdnt^ FtAlinx'^ jotulitm. 
A very lew eoatiof true pemn^uri^ »Uh nthfrrwUe xmirapf^rliinl lymp- 
tocn* hare beea oh«erved. U Jou not r$tij £o* prvJ^lit/n by frrmfV' 
Mm which dtlTerientlAlesh frcn th«in'>rviaipot!t&r\lfiuViti^ThC«,^««U'Mb.\ 








VALTOSE.^lls chief m:crt9£ lira » ib tj cocng n ccftaan cut* 
4f px^cmijc duuic but ibe Usu ue noc ftutxhle lor like pnctitioDCt 

GLYCURONIC ACID.— Thb nil«um(c nuy in muln anUu^ 
lion» Wwv fdWiHxV JviiiifMt, boi il hu no <kfmsie cUnkml ^piifi- 
aaer. 4flr% tua ndufrrf^ /<rwfftfit<Mi iHik yttaii ^mi it loflrtMtffjiS 
^id ithttitm. Tbc o&ljr <lefi;ii(e teat is that of Nfwburg, • dcscripCNq 
«| vhith rruy be fcntod in ihr phjiJolag[ra1 chemictrirt 

-^)tLt ii«od onLj oonuiitcr ibc Iwo formcT fiubcUficcft <fciic«By. Uiaqj^ 
It b prc4»ble that ilir> Hrr itrtivofl bocn oqlniiyrk »dd bj oddbnka. 
A <)Nlinction may be draw-n lirtwmi the dUb«tfla o( t nwrv iftil tbot 
of a mikl Ifpr by thr arnounl of t«Hoo« ind ihe behavfar of the in- 
tKtxa ftcd diftddic odd u effected by d«t, Thty uc prone in *{ipcir 
if the did it Ripdly fruteid ind ditt|tpcsf wbcn smivddiet bftUo^Mfl 
^ll^ ij they ptr^isi in yfHMJiJ^ ^ Aur Ji ftoJ cm attd I3k ohI imJ^^ 
iitUni. 'IV fti|[nif^cnii<T of ■cctono utd liiacctlc add it Mscniklly thr 
teirr fnr bi>rh. but ih« (hrnm may prrtrdr thr latter Biut shiwid bo 
*oughl in ^iftbdlc uhnea li diacclk b abecntn rA« /^f£fer Miif ^rtt JmW 
/tff, because o4 the simplidly of iU tcaOkiris and becauve it b cnvtri- 
abl) paiboloicical ihuuidi not <ixiftiicd to diabdcftr 

DIACBIIC ACID.-TtBt.-ll a Urn <!m|ia 1^ th« liJicture of ftmie 
dildridr br ad^lrvt tu ihc unnc in Oip pnvmccuf dincviusdJa Innlaimi 
red 4kppcv3 together with n prcdptlAic of phoepWtcs. For urailc 
mtiltt th«:* ifioitld bf allovrd iio sr( tl^ or bf filtfivd out \TiA \ht arUilon 
contoucd.* Th« urine iriu«r tw (rtsh or the 1c«l U cJ iko valur. 

ACETOfffi.-Ugat'a Ivrt.-niiiill a hv ce. o4 uhrtc by «*« a 
»imp1c Jiilldaliuu dask vilh ib nciL luikol antl ft* bttnl aim IcvdioK 
into a tMt tubf or izirdiiury fluk ; a buiucn burner or aktjhol biap 
completing the oudiL Tht dinilljLiF i-oUecied tn Itim Fovr 
ia liealtd vidi a Inr d>iop« of ■ fr»h lolutioa of Bodiuni 
a iinr dropa of mcdlc acid atr aild«d and Ihr loivtu rr rrtidertd aUuBck 
br aodhiDi bytlraic-. If Bcrtpoat be prevent a red apf«aiv dcqienbf «» 
camfot and [Hirf4f rvd, Lieben'a TtKL^MA Bo d&MiJaic a taw dnpa 
of Luf^l'i aolLjium and ^Kidiutn hydiatr If acrlout u jirtBrnL i| nill 
Icim a EBacroaiMpic or mitvovapc uxlimeni uf the slor like yvUov 
ay«iI%of iodfifofTTi and nn hraiinp thr (hmcURttic odor may apftfU- 


* Tlic iliuippcaiuirr or matknl itminutiiw of Omc coJor on faialinf Htf - 
fcnu tbr ptorcce of ulkylitlo « «h1 lar iJiT4ui.ia vrhicb maj ylcM ■ 
■ifttflar reaction. 




TfOV.— UtfiM moit b« tKuidacd beion decDmporilioQ or Iba finding 
juc irotth Citle, Ont(icodcnl>bnte thejialknCBildoiicortwo tfa^iDol 
a]nUl^ ttfi oufice of cald Htunlcd »i]uijcn of bomdc odd. m »li 
fyllc AfM gr. itx> to the qwtrt of nrin^ ii ^n^tirr Jtjf prmrrvAtlon, F(ir* 
malib U has dcninbte u^ It foim & prccipil^lc. 

Mxunle mknttcDpk: comu^HitioTi juv\ a^rnO. iritripicUlioQ ol uniiM? 
tedkiMartf deouod a tkoiough knonUd]^ ol the tpcdd [«hniquc in^ 
rohod- OlDKCftor bponlblc in |w«i cIinxllnnA t^ Thrt/uj^h hiiluri 
ta Mod iW^trfcgitf i t ii w rw u J <JffwfJj, a. 7AriiM£A HiMtiffrprrJafidn d/ 
rfff U ff iC i /MMi^ Krec7 phjrtkiin tliouM not onJjr o«n a fnlcKAcnpr, 
but bcUik loi0cil,iBd n<>iime(aiibeiDorepffdEilablTcmploycdihiiEi 
llul "iiicti if ipmlmtcquiriogflC0Ttrccir<hniqve. nr.whf>g™dualp» 
fmm ihc uhooili of to-dir, b or should tiir ininccl |j> a d(-|:rec ibM will 
enable him bo do rcMormbly Kcvmic vnrk in thU line. On the olher 
Hvid. ttmof emScfLl men of t1>r otdrr ^nirnLlkin Ihmu^h latk iif t«rly 
traioin^ Aod opfwrtnnity vc Mdly driidcnt in Ihb tm|>orlaQt br&ni^h 
of dmtcal m«dicui«. 

tiIhiSm^mi — 1q euralniAjc a urtjiftiy aciliiiwit mkroKopknllT, ' 
tkc fint fmttali lire itrrrt^t jMuitng Mid a tMHpcrativtiy 4im 
ti^hl Cvciy fn'crMci>pc «1i(tijM Itr pmritled witli jui iii«diH|j|ifriKin' 
And ■ tMtfe-piect holdinf; thrrc objcctiTox one low power* one , 
mfdiaiM, tiid for lh« third, a. bi^ [cwrrr Ail-irnmenlm Imd. lii 
orsujr work only Ibe £ol lwi> Arc rc^iuirtdn Mvc ta ihoM tAOM in 
wftddi Ibe tnberde bftdllu* tfl the object »aLight. 'Vhe phyvduti thauld 
commence opcntion* villi > dim liu^t and ba hrw^wnuf lent {) tncb 
or 1 (adi obJftCtlM), tboi b«iii£ by for the bral for Cording ca«U as h diR' 
liiNllj thotn tlirir outtiite aw^ prea a Inrger rield. Hr sliuuM then 
sigbtljr iBowt Eu? L'fihi «Dd brinf Iii> mcfiium power objective {[ to 
I inch) into form. Thii brfap oni Ihc rtninufc of cnsii nnd nmdtn 
diatiaa may cclluUrdejncnlBor OTVtila tLil may be prcKiil in the fidd. 
Hattag octe tooxnd aAy objr^t of Lnmwi th« lentcs and the ahimination 
mnj be varici! h< will. 

Sul«UAC#t louDd in Uriflary S«4imeot«.— Hie (oUirwitig are the 
vubiiarxd moftt fmjucndy fnund In urin«y taeiHtnaitt:— £xrriin«r>hj 
If^itri^ »ch as 6bcn of cottoii. ttncn. wool or tttk, nrwiaa vf j*c(abh9 
kirfOi from ibc itedng valvrH if it bo iini d1)trH!nl. sinn-ii-Efnini. ftfuj 
Ph^pMa, Tbc o«ao»cofdc afipcanuicc uf ibc phoAphailt: dcpoiit 
ia wHt Inown. The payiA^white irmtcrial so rvHcn miaEftken for piia , 
js tomfiiaed of unofphous tilduni and nugnaium phiH^ibaVvTi fct\^ \\i^\ 



itftdy Afjiubility in mtncnl adib a1 o&cc idcntiGo tbcnu Hier IR 
tomd only in [ilkxlinc unn«. and, if Linmoniacal feriMSttlfioii hu 
occurred, nil! Ijc L-wiiUivd with bcoutiM a>iiub of [be trifdc pfam- 
plutc. '^'^"■* photf^lc inay also a^ppcar in OTiUliiiiC fom 

Ctltiun tiitaMM oyild*. 

cum fboiphklC- *- Cft<<«ml> Hl- 

UraUs. T^c oMiiinr)' depodlt of untc* occun In fnodenldy kU. 
conceatintcil unnc ^luring lh« |>rooc«a of cooliit||H OT fdien H[iiwi1 
to au uutiDual (IcKin: of luIiI, Tbc lulor vuJm fpjrn \clhiw to 
th« latter conBiiluting lh« 40-ccLlliL'i trick dLjai dciKalt (I 
btcrkiuin). tFpnn ipjJiralion of hvat ihty prnmplly cltnpitfttr. Wbn 

fTVIplt» tiMpUlc. 

niirfe Add k ftdrf^ to ft uri(v rich in nrtlrt, « ifqutfCl ol 
ui« U funned. Tlic dq>u&itcd«fmlc»arcauiDrpbMU> txccptingi 
onunonum uralt*. which occun b umnoiuunL urine » Ihc so-cfllM 

lltlMALT nl SgDDffMTa 


VriC AeU.— Uric aad maj 1m portdplUlod from any unnc. \1 concon- 
lAird. ilunng thp m^oleil ndx\ termenlAXioD or in hnt wvAfiin whrn ^m^rIi^. 
ifac hli^ icmpCTBtitfc piicTcntA picdpitAticin of [hr utatts. Exasarr ^!^4(. 
>icir1i<7 Mk^ oonrantnttiM or l pftlliobjpc T3c« may c-ccur in fcrUin 

ji.— Ai»<x<uii*i arV4. 

»W, 4>j.-rafaMfi. 

^^^■ttpM-tuLk-A"! ^Ufi^. urine ihouIiliicirerainUintliecryslAbua 
H^W^ntcL The inacTocciopic flcpnul ifMrnUwi rsjrenn* p«pptr 
The fiikn«CD|ut &pLjc&nuicc b ht^ sliowri by the i^te (kh; fig. 130). 
CAieiim OxaUM.— 'J'hJA tnrvij iomts a riiiibk acdlfocnt and b 

n^ lu— <• OiUii- /. I.flffi«, 

iitk Aad uiint^xUlAlilc (kc fi|:- 137). LcikIh. Ijiorin. And ryilin arr ' 
rartlj tea. bul Hav bo mdiljr rcoo^iwd by cocnpamon vrilli the I 
iltiBinxhHM <«f« rt^ tj3, 133). I 

Cdtcitua C«rboEiate.— This ii cicauiofidly prcd^WjcA V^ S!ub;\ 


n:DTCAL DeMMons, 





«»rth; phoiptuiri. UtuaUy U k knii>rphatu. tut occtcfofolly itmta 
<rytlth tha^^ like a dtimt>bcli. It u cssiIt rccugoked by ibe eflcr 

I vcKfTtct producftl ndicn k ititn«nJ tdd is tddrd. 

I The Or^uiiztd ScdimcDt— Thtr c^r^muinl odttftHncniK 

: urinary ftcfiimcau arc hr mere impotunt Ih&n tbc iaon^nk. 

[dilrf rictnmbt or 3iuti«Uiic^« are: — (ft). BInpd. (tt). Fms. (c)> Sftf^ 

riitli). Ruvty one may 5nd ponfltc* or Ibdr ova UMi fai^ntttU of 

Blood. — Th« blood AA it afipmi in the uhnc my b« <iiilte noimd 
Vx KpprvuKc. or oti tbc oOttt band be xi chun^l u in Bult^ tis evcc^ 
nilkin difficult. It bcmorrha^ htu Inkcn pUcc in iJic urethra, pitauic. 
bIs'Mrr, urttrr* or lo The fcWU nf 
the kidney, asd the urine b «dd and 
Irnh. ih« red corpisidn ippnr ■« 
jdtow bicoQCAYC diXA with rMindcd 
edge* ftnd & li^l ccntnl [lortioa. 
If, on thr nitirr lund. the lioanT' 
iluL^ hiu» ukcn piftcc Enio tbc cor 
Ik«] ponlijo or xht kidney And il><- 
Ufine hu stood (oreoEachotiraorio 
Alkaline, tht ocrrpiuBctni may become 
paU ottd nii^fkHi Iheli dlanieicT lc»- 
ccttd And they may Appeal a^ fli^f 
^ladrrtey firda and u fcxich 
cfl^ly overlooked. Ow ia l iai oJ tbc 
nonmd evWi nuy lUo occur tn a 
unrie tbat b de&ckot m >dt. Such 
ccUa bave Imcguhr. flar4)k« pio c a t g i along tbrlr border, but nbin 
ihc yellow tinge of tlie nartnal cell, 

hu-^Pua ill quantiiy U Ifi motft case* eonly deieiied by tbc diemk 
teat^ Tbr pu& <dl u icirti undrr the miiroMope b piedtdy like tbc 
Ybllc cell seen in a amcAr prqAniim iif uonnAl btood, but b fan onAy 
reccgniied ai audi la the tirinrr In iWp i^rid iirli»e ifar pqi oHb afV 
tuuaUy iargcr lAon iAtf r«if (tiUj, cft rolcr/fjs, frdMJar gnJ «« orAft 
hfftv tfver^l imdti wtadiiy dtslmgmtked hy atrrjnt joivtimg. The 
pnaence ol thr>e nudd ccrvct to d^inguish ihem fioMw^ from ibr 
l«d nlle. Any doubt upon thit point may be nndily reonovod by 
aHuwIq^ a dtop of very tliluie »a.i1uibn of aceUc add to ruB bcnnib 
tkc cow'^ui. awAtbg the piroccan, if neccvftry, by laybf the 

lit IJW -<T.# 

nLWuraB-'njumBfntu . 




of 4 piece of illcr or bloUinc p«per »i:un«l the oppovtc cdgt. Th< 
aOHic ftdd diMolVM ibt gmnuUt »n^ brlngit oui cte-Arly Ihr Cffll nucldn Cbhihhi. 
Aaf imfeM tvy ^uk, %4it dafrvy any hyitiine taits Ihat may be pre^mJ. 
In amiKiovtuunt urine, the piu oxpuKtn arc «on cl«ln>7rJr beo)niiEij< 
■g^uHnatrd ttid Insn^ ibi^ir >(inii:iurHil (hAmacriidcx 

Vftrying Signlfioonct of Puaiotbe Unnc— A»tothc»jEnific&n« 
of poi in the trriae. il nuy be rvmcmbcrHl thbt («), Pui Ihat (atius 
wiA At fira jft of wtiK. At rtmaittdtt tdijf ck^if. h ir%>m ihc uictlira, 
<b). Thai a m^oderatt tjowitf fj put tv^nmnj in an ati4 uriuf it unuiUy 
frvm III* nnai fdt/is; but mjiy be tluc lu lubcrtuknia uF die bl^drr, 
(C). L»Xt y g Wito V j 0/ ^respfliiA ^m ^itf Jc» fuptHfo rrj an obsctsi* 
tMfi tht tiriitafj past^ts or tea pyehneph^oHt. (d), Fia in an ammon- 
Htfoi «nW il ftju«iJ7 /f^m rAf bZadJ«r, In all cvca lh« db|EDoait rnusl 
d«pctid upon ihofhin)clErofiheiuw>dB<Pi1epdih<>Uum uv) ilie pn«cn«i^ 
of cuts o( 3{:cci^ Eoitn^^Tj^iiismB. 

Spsrnxatozot ^n faii|y rpcognixed by their wcU known fonn (kc 

Bpjcteriurla.— A»ilc from (tie tubercle badl- 
liw, m»rv fomi* hf l^an*rii may br foimd Ln ihf 
imdccompoKd uriiic* and IhcJr pmcccc may be 
unatlendvil by lymplonu or accompaoM by a 
infiablr amcmnt oi IrdlBtion of ihc bbddcr. So, 
also, tn lermentmg urine ooc finds both bnctaria 
and «|Mn3t Tlic »pore»Arc hE|cMy rtfni'.tiEetnd 
r ufc-r i>« I '•"^l to fom<h»SM(i« fit ij(], lliCfDOfitim- 

iwnBiiii4nDt. iHfeHH porAni bartfTtum tiihrtubetvHehsdlliif^only to 
be rocognixcd by such ntiLiiung mciliod* as ore dc- 

•cnbod OQ pa^ 348. TA^ orJififlry baeSfrial uri«r i> pfrtiiUnllw do»dy. 

jbui fl nnuly cdfir. anJ ^r£ien(j on thaHttg o ruiWin^ appatfanu^ tu if 

Epilbeliuoi,— In Hjiiic of (hr rffnrtH pot Totth by raknjai.-opbt>, 
|A« asvcf 4ifterfnU9 msHm/; btiwf^n ihe «^UhfU^ ifUs 0} difffreni pertUns 
^ tht ttrimory tnstt han Nvh tmly in part ttftrrfnitteti. Such v»ruEions 
Alt Aon by Ibe pUto. but muat be learned from (he CAreful study of . Xihtrtn- 
Bpedmcfi* oblnined ftom kn^vm cAset M cystilU, ncphriliH. cie,, ^ ^'''^^ 
mere ilacifp(ji:Ki Mtt^ of ultj^il tslur. The rrmd all hs drrn li) | 

ibv uriM is luuaJly small, round and mononudnr. Cfiit /r«m M« | 
flfw(fAf Mkbiabj aic aonwnrhal lar^r and have a mnrt irregijlnr Kbapr, 
ttflnfC Aonclfaaea squvc or polygonnl, but all remti aUs d/^ movK^ nd^, 
* MoM coniDiocily fn«lat>& 


LtmiTB fA 





C^mdiiU niU amiiK«d m orcrUppoog loycn oiv often dcvcribed n li* 
di^nflcHfitk; celU of the irnal pelvis, bmuftmatltruf bet. they leprc- 
Mnt oiAf Ibe ^uperficiaJ Uyer, uid u% mcq only in cAiif or mild cwa 
of p;relitii. Tkf (dt fr^m Uu lif^p^ tay*^ ^'^S^y ftsemiUs tkt rnui 
uifj. Vrekrai (cUi Arc »pbdLc Ahapc4- BMd<r epiihdiym « jecDcnlj 
of the wtU fci^own IohUIpiJ or pai-fmcftt vnncty, utd E&«y h* A- 
luij^ui«hcd Fkhii i^jftiuj tpHheUtam <at\y by llie fut Uul ihr crtts Kn 
soncirhat f nullcr, n«Tcr i>v«riip. tod occur in ft tlttcft hjitr VafuuJ 
fpUhfiitm a miher t&rgcr; the cdh otrrli^ likr (he ihin^tt oo A roof, 
ajid arc likely to occur in a atm t anmiitt^ of acvcnl laycn, Tbc 
t^UhiUum jiftm Ae wd of Uit bUddtr. fr^aUHt. md tkt fotic4$ of iht 
kidney iidvi5 ht jtlnrrtT MrnEic^^ 

F$.tty K«oaJ C«IU uid Compoimd Granule Coil«.— Tb« foraMr 
^an mucli amoUer ihan Uie lane whiJi aic laf^. nnnd, bd^g viib 

J- LUEhtliuni 1*1 

J 'If -uifr ivrma I 

I rdnctilep«aiiJe«uidfmtUfntlyspIculDtc^Ly f Alty <ry»ula. Tlerfiftiv 
no exdusive dbcuc rrlatiun but majr br f mind in iny form of muJ l«ioB 
cfcAnderiaed by toijr <asb ftnd b othct cliivnic mfunsutor^ and 
ukcntive Inioni od th«r urinary Tr«ct m a ■h(4e. Reofti ccU« rc0r<l 
ihe cbuvcs khovn b> Ihc v^bii» <>}<& of caMx. 

CASTS.— Cam* uc oI two kimJA. (t). rA« J^w c««f. vhkk Aw fft 
mfin an an emJab A^vm Ahe lub^ of Out kidmtj. (a), TAtf ^tm4^ 
tc^% or c4uj7iA« &0ii«j, wkiih naj o^ may mil mjCMOir m ibe Wbn. 
TVtic Catta. TV <Taf f iuJhk dtv^ lotitft tj tkt Jrw puff «r« M ^««^ 
J1W7 JbK'K^ WIicUlct Ihcy c^)n»i»t of diaiuttgnted vid inocitted 
MpilhelikiTn, of a nuirt:iiii ffrrelioD oJ tbt epitlictiuzn. or »rt aimplj coami- 
bucd duLciuIa c«U4l4lc ii^m the blood, i^ /oci r«maJ«j CjboJ ji#^ e^/AV 



caiilntmntp^mMttgiaAMfchLmlromiifkidnhryKmr. 'tmt \tppfMring 
hyoUme, wory, fitnm^tt, f;rcnt44r, fatty. rptlheUat cr Htwiy^ wcontirti 
in Utf notmt »m4 crtfiil ^i tkf umlrriying pathfiiogu rMaitgts. If vt 
maumc thM that boiu a Uul pAtholo^c choiigv kDown aa hyaliiw 
dc^dttboD, u bcoomci wry nu^ lo undtrtund moit of their inodi^ 
ficailaiu. Sudt ■ jirooesi would lead onlinjuilj In the ^tnii4tl«i oF a 
Ayjlfa» Mit If tin pvnultt of tbe dcjccacraled cell adh«i«d boor 
bvcme micmdiiMl vrilh ibr drpiKdL a frruiWd/ (oil would nsnlt ind 
tliu ironld be iody or co«rvJy gnnuliLr* lljEfit or duk. according to llic 
activttj of Ibe |iAtholog>c procca. Fatlj rlfgenc^ntton in the cdU 
wotdd be rcdciclcd b tbc /aU> cojf- Adbcrcot dciquuiuilcd icWs wuuld 
tofm tpUJuU^ iAit, A.dh«mLt bloryi cdk. tbe Udod taa^ etc It is 
muMiblr to supfww iliat tbe baais is Uic sninc for all v»ridk«, and ihjii 


Ion* I '4 rmiJ 

tVTTLTiv fpMl rvllf. if Eoiilirlial 


rnl hipolh 



in the hT*lmc woxr. and ttbrinoux (aaIji wc Layc bdt alight varbtiuna 
fn slT^ctuTP. though the cnndtrAana iiieAding Ihrir pnveoce may he 
quite ilillcKnt 4nd dbllocl. uid llicJr ligiufitance dc^T^ilf uid Inipor- 
tait. Thf ky^iH^ eajl it ttontfannt. and thovfS ^n affpoMUlj Juma- 
gempta tirmtmt; Hi juc u vsrM62<; ri^ oh^ r^umdai, atut Us n'A/i arr 
luadf ^ofdUfA lu thftpe » bcM aho«n in Jac 141- Lnlcu cctcful 
locddBf ud proper fthwlEtig of rhr HgM b^ fm|i1't>'M ii wfll ctruunij 
nope dclcclioa (tn Its- N')- Rcprrocntkg. u thue bjulliie cuds 
do, tb« 1*UI drgrrc of pMihdogk or i| \tvt of inJ^aTnomtory dunjc^, 
il becomo *l ciiao a dilStiil quealion to determine: Lhc ftf^tAcutcic 
and impottajwe of an ^eauum^ cast. Some eib»er\cri report Ihcm 
■a pnaeni m ncairiT ertry urine if the cpjtrrtfugf bv cm^£^«^\Mi ipu^ 


inmtrAt nur.mKii;. 

trot cm» 


hu not boea the author's cxpcri«c<«, Occvmng tloat uid unti- 
■odatfd niih albuminuria, or othrr lympraini; pcmTin([ In iiicijiii 
kidnc>>« Li mu4t be adniiticd tlut ihcir tj^nifiuncc U less pnvc than 
irouM have b«cn tuigncd ihem by the olcUr lttcbmg> It it cvrtaiotj/ 
Uut itmt lliay may itpmnii tmnnimt and bcJicc ofirn ar|*U^fe 
condilioTu or LocAliKfl nihcr th«n ^ncnU renal dk*QRC« but m ft 
persistent conniiaent cif the urhrniy vdimrnt ihry iiill ilmand »^^| 
coruidcratlon aj)d hjivc Ioai Ultlc of thdr old sii;;n££c4n<c. It b a^^l 
much drhnrcd quMiifin sa tn whrtliT thry ire cvrr Caiind without Mm* 
^ptc of albumiQurui and actordiiig to K. S^ Wocid, Ihc hyaliiie («9l 

>^tf MI. 

PiCur^t iti hmI 14* i^OH thr ffTtci f^r ln« ar>i1 msh JllTiniini- 
irrm''r''p 'dVf la tb« Oum] o( llfbi. lajoiilr i^c nv^Bl cHl* it»ti*)' 

ia aJfrays aatocUteii vrilh the pok very 6ncly gronuUr cmL* It mpidly 
diiiDtAgnitt in alkalmc untie or in thai UVfticd with urvi^t add, Tbr 
«Ate/ siiniji<i}rK€ oj Iht hyalint urttl finrly ^ntntUor taU, OlEMEog ftluDG. h 
/otmd in Ihftr ^J^min^fUf in thrfmU ptitrtft C9ng4ttiem 4md imkr- 

Th« W*iy Cast— rhwif hi/^hly rrlrattiU and tawdty »f large lisf. 
tt Uj'ids fil/i jr citarty HpffK iht fifiJ >ij does th4 IfipU fka-ifkcle etytiat 
u«(f oncv iten, u ncvfr /«rjciiUifl. It f>^»tnu to one of xhnt CDttdklon*: 
^mylM Aidmy. o^jmuJ fAritRif pAt*rKhymataus m pMMi ««f Ahf 
fcrmimJ J^af' ^J inle/iHtiiU nefikriHi. L'lumttitia Aftto thAl 'A inajr In 
pits-nt in hibcrtubisA of the kidney. Id amyimd jNrfkvy. it appevi 
rarikr ihnn in iiUrntiiial nefhHiU. IndmL tM the hSStr U marks Ik 
frtffiflflMX <^/ '^ ^ Ju^d ouo of contrmcted kidney in wlucli it b Jound 

■TULi oi»Tmp>3Tj<l« Iji ilic Author'* t>wn ubttrvftitkins u &pfl){Em 
aary cb'ni^At vrotk und to tnf cub axid tnini t^ bavv & k^cai 

taoiuran— CAns, 


iriU iinalljr teaeoDMU blalljr viliim vrtt ytjr^ The l^bniious Casti 
-*Tbii nMB i n aJ cTfindernMinhict the waxy cut uvc in fobr, Ii is (^idi 

■Jwiyt jrrflfT* nr rrrn bfnwn. cIcrivitiE i» rdor Imm bl(¥xt pi;^rni. 
ftnd, ns nij^ be cxpcck^d. ffiinii h an ^ttve <tr 4ttinidiMt in^iimnvtii*m. 
aniinsri}^ in tojtfl Bright'« ilbvaw. Th* Btoofl CMt,— Thin ^tM 
h tfoiic iiiiCaiBiwatfgii, iu doa the ^'Vwt (dArk\ rroni'/dp toii.* The 
UtfTff gnmhr cauf u ciuaU; UB^daM with fibrinout oi with wa:^ 
carti. Tbe fittj cflri a tsost firqucntlj xcn b u^rrJuravf «ttMi 0/ 
*tmi^ im/ApiAu, at in fA/dfiu f^trnchytfMi^ui nrfAniu. fipitiuUfll 
cBitB orrur on1)P fn nfafr or nJWicuiir infammatiaiK ^ acub IMgktt 

Fir- m.— if^nulkr ciM n«hi 

n«. 144-^ Waif f aitt jk, Fiftv 



Hi>sy cuAi Cftfry here ocd thtre tn fpith<iijU fell. ^ cuidot prcfifHy 
bv tallol r^illiclinl <Mt». Pvs diMS «rc fcniu<l iJi luppumitvc dcmsr 
of the kl<tn«j or in pj^Ui vxtandiDf; to the stniight lubtila inc 
qurntl^ rvqiiij« tmtnmE i«tth dUtitr Afrfic luid to c^ittinguJi}] than 

Slgniflcuic* md Asaoclatfon of Cacts.— Hjw/Jiif ^m^ ftArZjr 
O^VNCtfr CfUl* iwjifti fc j"(a>. laicivtitial ocphntu, <b), Aiiiylr^d 
kbtefly, (c). Chrenlc coDgf«1foQ o4 kbJmy. H'dxy Ca$ts irndticlr'— 
00' TennuuJ slagc ol tti^c mli^miEbl nej^ia. (b). Adviincpd 
pftnmdiynalouft D^phritis. {c}- A»floid Iddocy, In ^fH/«dnj^Sr<A 
lUvftT Nrfkniu «iM ^fiir (aX Plbrinnui. (b>, Blnrd, (c),, 
(d). llyAlLce «nd fc). Daik pvAulai cuts. In tatnfjlcKc/ur. JromiAtuii 
w/Mlu cvtf finds iidty, itirk gr»nubr. ffi^ihriUI an>i byaJbf culs 

*U, 14 b laudlty \hr mc, Qk cul omcs aubnl oul cfUa (abnorsul 
Uuod) k ladkjbia tlvw cflusJop of biMidccahlKli origin — ii tuiiicalL VWvb.V 
toOwlwiftcUtii hcaoorrbac* or an r^nipii id ihp iiUtdi^ lubiJ&Jt» 01 vfKRuAi^\ 



ucnicAL rtucHogvf, 


^nf fmniv. 



l^alln^ ud finely putulor cutt arid wfih ftnjr dcctded daM«rb<uic« 

8ourc«t of Error mSMrcbuaief^r Cuts. -^<M<''Ut/'«rflu. TW 
amorphoii* umTa tn fm^u«i^tlf gmuprd in cut -like femu tuid sittiUf 
AGCumubtlon* of bacteria ^tttl cither 4t>lmicrki«r> *ub»lvic«* iiuy |jct' 
picx the 1yr>> 'I'hey will Ftfldtim cir nevrr t$cicTit« the 1r«in«! cyt «kft tbrj 
Uik the <l«GftTlr^ tKiumlHry^lJtic of lh<^ g^uirtt uut. Unt0L morv- 
ovcTp ut pnomptlj cluaolvcd b^ bcolin^ tlie pjvpmtioQ, Mom 
(^Kr|tt[w »tlll an ihe cyUwdrtridt Thty uv qtcra^Jy loo^ Mul 
more band'lilc than the hvalJnc ubd. anti more Ukdj to be coovoluk^ 
or twudod; uitulijr iliey lake U<e form 
htinwii a» niuu;UA <>laLdiviii!i whitli 
occur in many ncc -albtimincim urix>rt 
and oincol be niucaken for true cul« 
aa Ihcf appwit fljsHcnctl *nd riljbon 
lllte, oficn wi(h (myedc-nris uicl (ami 
loDgiludinol siUiBliui). Tiie AUtlii;L br- 

[Ufvtt Uini few«r cut« would be re- 

' poricJ in oihcnriac normal uricica j) 

ffmns at Jij^mifli until he could find p,,, uv-Sfr.^-*™- -m,-«- 

m tbc >An« Lirinc & definite c»li of the n^ri'**'"^*' *" """.%*'S^ 

onHnary du and form and wiOt both "J*'^^' 

cnde rotuide<J. // 0/ rvnoi iviVi" 1^ ■•^r 

Ay jAtf cMMHion yrjrm. In a cam inailE; ubacrveO |Jcrio4» of bypo- 
cboiidriiL were amompnnicd by tk^MKrt ■;■[ -^urioiu onU vilhoM tbt 
fJigbiwi chaiip In ihe cbfminU fviniiiimiian of Ibe udDC 

Pro#latk Pluc^— Tlv;:ac may cloacly reacnble tW larfc hyaline 
or fibrintjua caic but usuaJly carry or are attodaMd with fpvrau' 
locos, and mic oseDdaled witb cviileacv of picatoik imUtkn or 

j Ttw EiaroUution of the Urine for Tubercle Badlti.— r«6er<£< 

baalli nay be [^w*d in iirtrfo fA^if 4fi m tv^ry Mtr rtspal ofiMcr 

ruirmai. Tf fUirh a lY^ndlfion he KiitprriPil, ihr urtnr mtit* hf fuhjersfd 

j to |irti«agcd tmtniciit in the ccotiil^^ macbine. Tbo ecdinKnt b 

I ebon evaaiiried precurly ai ir the caau of ifae ^njinn (aee page ii^I- 

^ Mite Ihai a nna!l ^juantiiy of rgg dbunua a added do tbc speiciaini 

before jdadnf* it on the cover-up. 


ttnf>iAt.^n»-HacMoci>ca»— ^rv^nom. 


THE G050COCCUS*-.\s indicadnfc the iiiject»it]r oT uiy per- 
tktml vFiriicT^ at^cT irmhrifu iht prco^cc <tf noneakcd k Imponint. 

Mcdwd.— The uMid acocai i» oiade. diicd ui Lbc Air tad fixed. &ml 
imbfd m*y b« mad* by Ifct pAlitnl il no dlucbargo ie [>nMnt esv« in 
Uk cvljr mDmiag or tA imgular tunE&- Ordiniinlx il^ Joioer'a vttic 
or Uw ADtftUae mohjlcne blur ok vifficknc- In *ny <ust oi unuiuoi 
importem h rruy br cnnaai)- ta use cultural tnHhcMlE lu 1l U claimnl 
ih&i ilw tnktocotcu cUwrlMlia maj c*u>c confiulon. Tbc»(>-cal]td s^irvdi, 
iwttMrat tkfMd, ihovnb conunoa afltr psnccrhnal iofriciion. MuaUt 
no ntdrtf i»^ ka thon vkumic tVHftidcn c} Ac 4rep arrUra. | 

UUaiCU'S ITPU0U3 DlAZO'REACnOR.-The lost vru 
inUodncvd by F-lvtlidi in iMj. ami, afitr rrttcling much oppnsiiinti and 
critiannborQ a( siisundcrMAAdinjc and mJaopplicAlion, h&) nt luC btcD 
AcwpUid jlI fu ime value en tacta ot ihe impnnant rllrklcn- 

SolulLona Required.— 5cJ«itim A. HrdrixfaloriG acid. 59; db(jl!td 
wAtcr. tooo; tdjihanilic actd. q.iod aat. (Ahould bv iharoughl}^ aatur- 
aled). StMcH B^ Sodium nimtc (nat aimEr), 0-5 pci cent fl of 
i%X MlndoQ in diatiUed ffal«r SMiiiiim C. (Teat Solution.) Om, 
t Mn dhri pa/nof A plxttcmtf fan <*\ H. I 

Tbc ofSfwl l<3t poluEioQ of thr^ch waa cuidc by aildlng lo 40 parta 
of SoliviioM A I part of Soluiion B. Thu ihr author has vlij^Titly modi- 
fied b}r uaing 100 parta of A to 1 of B. witft the ciTrct cif cUminatiDg 
muijr dilUiilkiiif iacton aAd doubtful rvaclioTM^ Dr. C K. ^mon 
■iipjcin it the ring method of lEsiIng ilncritwl below^ 7o n/ip^y Uf 
Uai. loir «ifii«^ ^drt» «/ C imd tht t/nrtr. Skakt ih^ff»i;iily enJ odd 
dfuii dHMBMirid 4m «9e»u« rtJimi^n^ tJ in nm grniSy d^vH Mr fuAr ro^t§\ r^ch^irt. 
tf«y:rJ0y Ji< mwinra 6«W- U the rrAction be prtaeot, a 444p-rt4 6«iid 
appAiv at Ihe line vhcrp tbe Axmnonia mnu the muiurc; iA-brti 
fhakcn, k yidila a ^ak iv tvi^<Uortd foam aa J jifter ftlanduix scrteral 
boocit A pcv precipUaU foran. The follovkn;; rukc miul be auv- 
fully olMCTVfd:— (i), Vst truk vrin^. (r). Srv that fkt rr^Aiim h 
OCkd «f*d Ifcc ■n'fttf ^Jlcrcd. H). Uxt n Jriesk leiS'Te4nIii}H. {4}. Ketp 
Ik* tedi um mtritf ttittHMt m 4 hUft bnltU. and m a cool pta^t jnd romr , 
it fnqmtt^lly. The flp*^*"'-- wrliLtioo Lnpa bddtnitcly. {5). /foAJ 

Mfad tJtt «6MT«r, ArHXdd Si^hl ik^uJiS mt U aifd. (6), 4tapt 

Uu jeittiiMt vAm rfcalm diots niif yvCd n ^itfr /c^w. Pirudo-rraiiumj 

occur B whkh Ac band is of Ibc proper color, bur ihc loom ia yellow oe >^waijw 

btfovB. Tl>e awM aboard erron have an»ca frim 1 tuWra \a ^atem.-^^**^ 






K»l villi F 

I Itc oott Uchckiue hot ou;lu]c<l and jomt oxcUcftt tpcn bovt usrl 
: sodium niinie. vrtuk tmmoaatk, or even omilled the tddiliao of junmc^U 
■llojccthcf. mnd natursUj LUIcd to ^ cnn^tfcnl roBulo. Oih«n» li*it 
Admlitcd ytUoff nod ortajee Roctfoai. <ir Kavc <*ai oaed A 5% Bolutka 
Af irdlnTin nltrlrr, Th« t«3t iq noi p»ihi>giu^mVinEr. ut wu origiiMl^ 
nuunuincd by KhrlL^hi bul u coDjUuit in a11 severe fanna of typ4»id, 
' appMring t.tmtiimt% u fcrly u the fourth or fiflfa daj, IJhnvj-lr wr^ 
gt^fraUy al Ifi^t md of the jirU ttrtk or kn dap, uid pcnkliDs vnhJ litr 
Jntf t^ns to d^HH. U the tc»i be ipfjliod ucardinii lo ihc author^ 
iQMhod Lh« iru$ r?u;iion la slMrfii In m&lArEa, ap|it»dldiU. ])nctimonk 
' and the earlier fltai;c3> 41 Irut of •cute miliary Ciiberciilo«U, occumog 
only In th« tuihor*! ^iprrimor in tomo of tb« »aAt]mnAtx in 
CA9U of odvoAt^d maiignvil diAcuc* blc io iniliuy lubcTCuloM 
fcbrilp ciu«» AuociAicd with jr^V oMorfft^ Pwcdo-re^iCtiont »r 
found in ft (oti]iiilcr«l^ number (if dltra^tA uid the Indui£on of jtlkT* 
and oran^ rc»<tion« tiu diArmiilcd d f;uo<l l?«. It b of gnftl vslur. 
&s a lU-KHrivff 4^gr. foril i«irHmitbr*r'« Tinn belief. 11^ UwiXth^fowmi 
prtseni in ali scvcrf otni of iyphcid. tmd iM Af fiersitkni gftictf iii 
<Lity iiich fjff ^ifif^ urUiimly nf^ativa tk€ di^gnotif ») tyfikaU.* 

URAHIA.— Any funu of BHiHil's diseuc may be attudalcd tiilh 
■ymfiiannt grouptd und«r thv hmd of "urxmia," The cmct ««>e of 
thii condition i*( ttnknown bui iu ocnintmcr dqimil?! ufirn the rrira- 
1»n of «nuti ucniioa protluctn duiiincOy lone in tbci; paturr. It » ■ 
WtfU knnwn fiict, ihAl na livitig arganism t4m rttisi tJu fait$mtna t/eti 
of iU tft[>ft watk pntduttt. and in the cUmtruttufi of that mImUbco ik 
kfdncy pUyfr the <bitC p»rl^ Th« ^rmptonu oJ tirania nniiMcknitfi' 
frat ilnctly Ihn^ugh ihc ntrjum iysUm. although the ^alio-vtesdnnl 
■fld rapLfntarv tracts irc alini:>at inTariably invdvpd. 

HervotiB Symptomttof Vttt^mlti.— Almost rvtry diiftfJEff/ ifcff iwrPMif 
sysStm may bv jimtUakd by iirxAfii, but the (Cf^brvJ i^mplOBM uc ik 
'mo*l (nienoKfng ani jmivinnni. HndMrh^ drow^oi, itupor orconi> 
BXiy be foimd mili^i[luAlJ> or tA tiaiLsiLum lUf^ Tlicrc mijr ht lU^ 
i tm^lthlng or tb« more tcnibte convvki^Y t«uur«« d^wty sntukliiic 
[ qrilrt^. «iid Tuvlcni nuihreikt of af mc irunia. pmround mcUnrboUi. 
or the fO'<aUod dduaonftl inMnhy ol Brijtjit'* diacwK may cwly Lotd 
Io srrioiit cmr fn dlttgnMb or rvfn fo rhi* c'ommfiul of toc^ ptiimtt 

^RecmtLy tJnverrkhr In questing MJchnrtte an <TntlnHta>iileA4ne*r*.tei 
nUed uicw llicdd quoiion of tulor Hiid Jrmiinda 1 ist nc drABiiP rrankia 
A it^p nd lo^ and 41 o|*it Joam may vid MnW be dcnuuided bj every 
cUnidao bdcre the ImJittdua] itsdioQ ik dUUvylciL 

CASmo-urrurrcfAt ainuTOva. 


10 Wi uyluns Cor tb« favMW.* Varfou* ^tmrbanut of gtrval ttnio^hn 
may be tnoMiiitend wdi u kching. xucithuu. bn^^ncslhesuu furml- 
cftdon uid AhncmoiLl mpaatc tc beat m4 coliL VtrUg^ u often a 
prionilfMnt retturv nful d tuni^y uhuViIEbI wlili prriodi nf mnrkril 
drcuUeocy tJepru^on. dimmution of lotnl noliiUcir liic prcilonrLlnancc 
of thi djnpfpik fjmptontt, oliaQ to pronbwm a ffttiivt In thb <]iwas«^ 
TW BKOl nsuukoblti iymptom» of ivcnua vc ihooc <]itr»ortluiary 
»llAck« of fvafif^*^ or htmtfltgio dmuUling trij« apoplvxy, and Ibc 
JuAarAaQM «/ M« spttiai xhw nsuIlinK m iincmJc tiDnilus auHiinip 
<le*lQflii or VLiddoi tcmpcnry btindocu (uremic AmiiurDHj].f Vanous 
murt nriMM /^ lyn/fiMu niAj cTM^ilnr ^h iirnnbi rtnd lA/ dia^nahr 
tf j £%rvf*£f inlentiiiai i»tphntu is &}tm iirH mode hy Ike ccfdid, wbu dia- 
conm nidtace of a neuro-rrttDitis of thr a1Luiinmi.trk typr. Urapmir 
sauviwb luuallTUvbLutDacoriwocUyanDdardLDAnlT follows acme 
pnrfouBd BunifHtAiion oi uratauL.«ucliutomiotcoavul0on«- C^sa 

RMpiiatoiy STmpComt.— Cun of chronic ncpliritic ftiv ofira 
podiliuly ntb)cct to inlUmniilioa of the jkulmanaty stiucturTs^ but 
ukle fnm thcfic vc hftw cutiotu dufiiT:fri7i<f«r of rtspiralory rkyihm 
ud mvnifc d>^«iincr» nu/ be crartiniioLK. i>ftmx>^rial Altcm^ilnfi. 
or CWTRC-Stokcs- Thi panarytmci iy^ it ojlff miitjkn faf Irut 
Asihrmt iht niodf and lime ol onset being klmlical. C4miniuaut dyS' 
/Mffifl ol unm^c orifvi is i»ot vnoovmoo. vtd medics] litcnlure fur- 
ikkhM mam% fiidmcrt of ui vitMokry CktjtttSioltti typt-X 

Gastco-iiitestUQal Srinptom*. — Tkac to Atvxfy simttiate vafifftti 

Ut tJu arinr *ud fieriituiarfy Iht aiSmaiiBtt of urinary soUiU. As pn- 

*A ROkuluUc t^tt ICL the AUiLoi'i pmcliVt: iliuwr-jl llic einLcni:r of a 
unmdc ddiBidU, ilnek but used and dvmiiiAnL wlucli La^idd «Uilj[ tbit? 
rcAB, duriof whltli pctfwl llie ptticfU wm converted ttom Ihc ■fwmot 
nvmalnp Id Iha E»ott laittc oncnitTi nturainff tudiltf aly to hU tim Tiatun 
ftil the end ot ihc pcrfod. In liiiB csut ihc Utnnn^viU vu Enlrnmiienl 
vith frf^tivnt pcvii^ of Burkrd ikbdoofv of eicr«tki4\, u iaJk^ilcd by 
ttum^tni of ihr iirntry MtfiHt- Si-vrrkl fi>i|iiriuii prnnnunrrf! thr mtn 
wttpOy fnr fram dJ^Hru. htirviv nf Oie nhttner of tllmmin from Indi^IduAl 
^minirtt of udriA. 

t AnbAUJDabi L r-, UtpdaeB iuuaU;^ lempaivj OMjd rtnimab^ 4iid vldi- 
««l oppaRQl IrvioD DM* tbo be cncuuntend la hrntnii, ntiiErLinc, uute 
ivvvn Banorrbagcv^ lowco Mkd coAia* hiiUaiatkin an'] dub^(c4- 

l In ooe CAM 111 tbUn<iii*l MplfitU in th« ftuThur'i prvike, t^pk«l 
Cb* y »i S la fcw bnndiinf wu pnMnl st ni|th( lor cn^r (hrt* fun W<A«^ 
the pttlkai'a detlh tad vbs otoulandlf prr^cnt In the it^^'umG^ 






luuiCAL piAunwri. 



vbualy fit4i«(l, ttce* urttmk ^^pionu maf b« tvidtnl b «aj cbm of 
nrphriiu; thr author bvlirro ihat tbry my alM btf pmrnt fai vbor 
ffc^Tctt at Icojt irithout aaatl s^phrids. if the ftranbiMl ActJuEif or 
<itpadiy of the kidney u tcmporatily denn^or Um. NcvcrUukM 
Ito cwM citreQ^ ii:t«jiUcsuikjri& ^n tacouiilcml in Jiruoic inlciMilid 
oipliritJi^ or *v«n mora commonly in cbronic ^iffun ncphhtia mt* 
exmlalitm* 7'hf! mut-i nf vntmit is atouijft iiwariaUy aist/d^ied 
k$itn€d ifuantiiy cf uriiw and a sharp PrdtK/Mn «« tCliU tftids ««i 

Uremic CoroA.— ThU mty diMply rimukie tpaplexy, but \a rsfdy 
«0 Audildi LD oiuici and U more f^cntnlly preceded by cdotvUoo^ ft 
hiMory of vhlch thouM he c«rclully sought. Sncb catM aj« tbf httt 
nmr uf Jic li^opiUil pliyaJtiaiL uu uttuunt c^f ihv liiOicaJlka id djficfin- 
tialion. The loUi^wing poinli Ahctild bf noi^di — (a). An ^i^mitu- 
Aifffl v/ iHe urim ohiaiiud by ctUktimiaiioH u oj ike firsi importama. bi 
it TPfty yield ciidcncc of an active or d^ronic ncfihriiia, or ahov a 
maricr^ rrductSoD In vAid$. (ti). A Msicry of amitcfdmi rottndnoMt 
ot ccjuvuLuic moi-cmciita ma* be ubuunablc. (c)> Thf pupiti yitH 
fw MrTiaiR rignj. (d), fArtJwfi art rare though there ouiy be mtm- 
ralar iwitching nnd rigidiiy of the ritrcmitirs if nrvrA oMruUaai 
bavc occuiTiDd. (c). The temperature may be dcvakil. but tuuttlr 
h in ndrma] nr Ruhndimal, [f), Ophlkttlm/ntatfic ^xamin^ijpu iB«y 

ii*4rly inii<^U Xht txiitvtist cf mai dtitaa*. (h). Xillb 4epmdtmf 
MK tr j}£»cff ii></n lAc oitfT of the bna^ m* bdicatiog rmal touimiL 
UrsBnic odnr U vwecCp iuascat)nj[. cfalotufonn-likr and may ^- 
vftde X whole AfnnmpntH hut U fmmd In cnnnenlon iriib praCMmd 
miUlirf: fi^u cardiac fadurc, advanced bcpatic dbcMC, laul 
Mad •OKtFrfmn fn conii«rti<in wLih tnuJigiunt gnmtha. tt lazHtt 
(he pccubnr quoJity cf the htznih w CRCounlcrcid m diabciic ooma in 
which there u in Actual fruity fragriacc oC the mod peocEnilinit qualilT. 
CRYOSCOPT.— l1jeEmrodartJon«rayo»COpyby KcirinyiiTpn«cnu 
ftA cflurt to sMUJo more ctaid bf^fmftiion capecUly conceeniD^ wad 
iflfHiy xnA i^icyfney by riMprminln^ ihr invthtg pofnt of (b* bteod 
aadiuinG' The srcatcr the mokcularoonccntralioa of « watery fluid tV 
knrCT is lU Inexing point artd assuEmng thtti Ihe avrrtffc frccmg poioi 
«f oormii bloctl ruiiec* from —0,56^ to —0.5^^ C and that od tbe urine 

*A ca*r BRdrr thr aulhor'K ahvcri^ltoti lattvr yfWiihovrA duriagilai 
period amif vrrry iriEtptatD U> vbkh iduT!iti:e hu been Kudc ID a pi^ 
ceding pace- and ABUjoaic ihoc were aitucha clfM^ windatiaK by«Me> 
but pronpdjr peraovcd hy radical thorapnille f»ca«URai whOe fto toa ihaa 
Ibfw tinea DcC«rc death the paticeil «4» fouod in deep uramtc ociaa. 

nnunfi vr im umncv—c^wficon. $SS 

b«Cwrcii —^^ tad —^ C, it it evident ih%i the lower ^vegntt|(p«nt 
on the put of the hlocHl icdicala m gpeztcr n)ni:f:niiHtIon vtd llwl r 
higher fiicuc for tiK urine indJcalc* a IcMcncd molcoiUr content- U 
fuflhcT iippnn th»l » ini of thf urEnr- iaIiti by caihH^rlxaibMi ffom 
akch kidtKT nug^l dcbcrmiDc Uif rcLiiivc fundionaj actiTily of tboae 
otpAft uid that the pnxnlurT would provr & gui<lF to Ih^ Eurgeon jn 
flffphrrcioniy u wdl u ui the phi^uji m {(mnciilon ulth the w-nllcil 

THECRYOSCOPE.--ThtKo»iHiririfWrumcfH*(«wiw[UH<if afrrejt- 
iniEchanbcrcontAiiunicapcopcrlysuppcirlcd cfrnirut lube wit Kin irtidiTCl 
moochertitb«niAybrsoadju«1rr| u T<^ Era^van hrr chamber between Ihun^ 
Willtm Xht Llicr h a dclif^tc Ihcrmomclcr rirf:i»lcni^£ from— jf to j" C. 
in f>r«ltiiilioM <ti 1-Md Bcd thii it cndrclcd by it spdrdl iiim-F, neither 
iMJchirg Mir- ddcfl of the likTieriroA tube, BCflUwd.' IV Ujyy iuIh-i 
being ia poeiiKXi tbc frewAg cbambtir is filled with crocked ice unci rock 
mh in allerruiie byen trnniiuillnK in an ujipcr liier of «alT an inch in 
ilcpth: to cc of tlw blood or urine haw io ihe meantime been placed 
wTlbin like inner itst'fvbc and put in or upon tec lo cool durin|; the prep* 
aniioH of the fnrjunx uiUtuic (5 tu iq inifiulcs). Tbc siuiiU lube ib 
iben plKpd within iho Ur^ one antl tUlf>d with lh« th«miomelcr, can; 
bcinx iBbcn that the laller** bulb n imnwnn^ l>ul that the instrumpnt 
\9tit10 pc*nt ia contut with the wnJI of the inner lube. After about 5 
nlntttra ol eonrinuefl siimnjt n tlcw fill foIlowM hy a mpid drop ocrun 
1o*bout— a*C»*whrthf«.iini Ehe readbj^ is Atikilvrnar^ f'lf sumc mmulra 
and t^en rise* 10 the true fratiti^ /omf, again laUiriR i'> tht- teRi]-K*r<iiuro j 
nf tbe frttnag mlatiirr- The rcaitinj; iihoulii be nuuie with ihr rye* , 
ai ttic k-re1 of the mcmuy column. It i» aAoumed thai a frrejinfC point | 
of — otf C- at bwer for blond and t* C, or highrr for Lime indlintex « | 
9\i^acai deiETM of rennl inef^ciercy to forbtil luit^ical inlerfcrcrKc^ 
A* migbt b« expected ibU method haa iu eRihufliatiic advoratcs and no 
ksB iircniMius upponn^b. Space wiU nut [<n>ul a full liiscuasiun of 
tbc Kireftjph Of woakncM of the proevJun, but !L junt id«a may be ob- 
tnknrt\ hy rradlng &ihfi*s a'lmirmhlc. crJirial dLv.-uiBion.t and ific bonk 
of ilA c«tlLU>iAJi1k advocAici. Copper and Kichicr^t ^^tch canf jI <Ai- 
ftrr^r* aad rnibuLhsfir wnrlem ah DaCmtiL nnd itahut are unwUling 
eoaubsoAic ti> the claims coailE lor iu and to tbeauUmrit dpimsnabw- 

* Made Li* 0- V'Jbtiuae. lA Rue UoiutVur la Prince. Tutit, « tbc highly 
jvcoaukccjided modiGntion ol ihf A. H, l^hnman Co., PhiladeJphlii, 
t-'IK'itBMlk Mtihoda." 
i ** Functional Dia^poik it Kuiiuy t>]*r»4v." 



mcDBCAi, njAC3nic0^ 




Of tmrr 

hildiF impcKticftble sa a working diciicaJ prect4iiie. ait4 one *o wbjcci 
to irrfouft error fiom sVglil auUfa nrd to vridr niutKm In ap^miijjf 
oormal cues m to cut tmc doubt iL|Kin ihc Undinfi;! ubuinctL 

RHIfAt tn£FFICIENCY. jKrnal inidc-qucy.) AAidfEnmoj- 
oiCdpy mimydlutla luiv bcxii jiu^ciuiJc(«immcihc fuciimui] cfiickciy 
M the kidn^rv* especially viih relation loKcloalor nispntctl tncdicAler 
Milled dbefl» cf ihow oT^nx bui «> fu^ iw mrUuid hubrcnrrohnd 
which ts int from seriouj objtciiaii uid at lima iprm cvron., Inted 
il vtnild IM^I nl pmmi ihRl ihi? cxcreibn of toiAl lolfdft as TTprM««kd 
hy the apcdfic gr«vil> figurvk uid ihc H^^i^l iirotcduic bx Ibr clelfniiip< 
Ation cif lutft uid th« ctdori^w offv Di« bevl mran« vmOabic for the 
husT pmctjtinner ^ Tat u ihc prnKiu^l «pcncncc of ihr nifilior r4 
conotmcd thtM btvc pmvcn ndcqtutc and vHom iniaJtaidin|> in mediul 
wiirk and to ihrm r\u ohjeriion cmn bn ur^T"! whifh raruird tjo mH bf 
m 9t\iaX oi gre&tcf G(>antc« obfuiv'n io the iiruponed Mitifttituta., IV 
ertinwtum oJ t«ul niifogm tx\ h«nl!y be a(U|3t«d to the cmniiutiaii 
of Hpodmcni obtained by ureteral ntbeUriMtioct nhlch rcpTwni wufl 
Kp&totcspcdsKiUiittid furthcnnoix involves All abv^ljlc knoitleiliscal 
the [n^rviA, 4ir excfnlon thmu^h rbjinnrU nihrr th^n ibr biilney. ■ com- 
fdittted cbcmkal cvtimatbn. and iT]>c«ted te»ta aneriag a coostdcnlkk 
period; ill of which rMiuiremnktA fUrr U mxirHy &%Ufidt tkt f^stihiklm 
ej dimuJ work unJtr trrditmry 4viMims. 

HMhylcao Blue- Achord Mid CuliUKnc some yttat n^fft 
rfod and xnKii mnbylme blur fnr the dciem^inftilrm of the ftnokini] 
aclmty of the kidr^yt. mng^ iairunuK-tilAr i^ijirictiofu mnd oodng Ite 
lime elipuniE brtvefii its ftdroiDlstHLifon *nd ibe «jb«equeQl dMceJor* 
alion of ibc unce w «rli aa the appn^ximjitc amouol of Ihc coloibf 
mftUer itcoreivd. It bos been found. howcv^Tp thai Ibe test b d link 
taluc wa mctiurc of renal jQi(j]TLi.iiT(ii:y< the clIniinjitEAa bdn^iavnud- 
ffied Sn pamchymatoos and unytoid nophiil^s, Ibw proving thai 
Important renal oDnatltuntu do not ftcia«iloea the dye. 

Tlw RelaliT* TosioLty of Drin«a. - Baucbard'a mcthodof ddcntlm 
ing the rdative toxicity hy injrcimg uriac iaio guinea p(^ ia ao (all ol 
tmr vaxlatlona at lo b« enutlcd to little it^^tKU nov la h tn any way 
adapted 1r> '^rdlnafy eNnfc»l woHe- 

Tb« Phloiidcla Teat-— Tlieobjettiun^tti pUcetdonaia iCAanb- 
5lnnct ore much thi^ &une oa a^ainM methylene blue, iboucb il U }«til>- 
flble thai an auimxtkm of the ^yrosuHa fnllowiaf^ the admbiWiltBa 
oJ this drug (uniiibca an apprvximatc idea cf ibe fnncikoaJ cofiacitj of 

Dici:Ani: Oir nn cidktv— covGRffnox* 



CnnMiMlt.--[t would scttn to llic iLUlhur liiat ill view ot lite hcl lliac 
M> VDobjariio«i«blc or ifiUUiblcmclhodha^bHn evolved, one UJualificdi 
In bOInf bATk upnn those thni ue simpWr nnd ihnr ficmUh (lia:c&1 
ROdu of dcddcd rijcnilicanct. In oihtt vonis. unJaf frctirr mclhadi of , 
an a^/vnl* otti AvMy tuitanr ^ntd grMSdt ttrnfUtily art ntthrd. 
the ^radMoacr is puH^M J'^ J^ptnJinf; ttpm ike li^uih tjHmaiitm of 
totM s^dt mtd fke a^pnximatt deirrmiataiioH 0} mtfo^ hy the wta* cm- 
Intf \i % mNllcr ol fact Ld tbmc coadiliDiu ojwadiitcd wIlJi tinrn-iir 
cHiOft ibrrb (■ addon lay doubt w lo the lemporMy or }H;niuACDt 
diMbJIiljr of ttir kirlnryi. nor. m A#r/iQrr i^jJ^ U jAfr fonfinrd ax- 
tkoMy y nmd iiMoJc; ibou^ the urjnc grvfB to beat MiCAtion. 
CncM obOffrtiioD <sS ■ mrJmt of aia ^f«MvriMj b^ symptoms cf a 
wtodijtti MTtfiWM M uvfA appaffntSv ncfmai kldnty^, and a} ptftiidy 

0MV7 Mc pj tk€M€ AMfff, Ufttk^f %Hih t^ JiMpffor^xftKe I'} aU aynpUrms 
wm4a trwtmfni 4irHifd to O rrsSoniUfn of rrwtl o/fiVfitjr strcmgly lUj^gtttt ' 
Ibc ponlbiflirr oJ i ^nref^ fnmctiimoi imffkiincy, uaociiicil nilTi rcii-n- 
IboQ *ymptioni*ticBU; fndiMbgotahflble from the unrmia ijf iinghi's 
dferuc. FuitJMrruiuic iu aD (iKKCtMaDutvttly wM llic ftpralicgravil; I 
ifi"wnml but una wna in cvny caM ktt Ihttn Ao// llw fMfmji. utdij l 
althDOgh thff ilirl v.-as uniforni, cr^eaEion of sym]ntf>inH ind ihr nv in ' 
the UJV& percenUj^ and spcdftc unvily were invanablv coinddcnL 1 
Tim B a}irajrs tatoiA iind vcondtfy to HUeatc^tif tlic bc«iu limp or 
HvOT, Ot to pnmn on ron*! vein* by »b<1i>mLnft1 limiorB including tlii! 
preponl ulcras awl wm^tst lldd. Morbid Anatomy.— Ttip kiUnrYK 
ofdioarily chow a «mple venous ti^'penrniLa. 

SyiuplUDia. — Tbcre»rprio<ympionuof impcwtftncewveihojw rtfer- 
able lo the primaiy loJoTLt and the imury findmie*. Urine.— The ' 
talaJ amouAl Ja ifthninlshcd tAlAl»o1lcftappnu1mftiely<>ractiialJy normal, . 
ArofftVfl.— Aiai Color^^D'Miniiiy lii^liMicin [litcumJiancii-tiudi 
bv moflcM impaiimfot of nutnlun, ^f^Hintit tsprfr'-ni i^ly ut a trni^c! 
nrep< in prTgDaAry when Urge amaumis may bt fifund, Hlcmscoplc 

m few nrcul fvlb 

Tlia KIdtMy of Pr^t^u^Dcy.- Kivn though tlicoociilhiorL may be one | 
o4 Mopic ppc wwr e bypenrnwa, the tmount of albumi^i iv lilcHy to be 
Urgprr tban in ctbrrioiiaiKa oF chronic p«9aive<cingcstinn> and htiuuai. 
Dot be for)CDiun Ihai ailive hypeivocua or acult or cbTOV^Avt^^^ 

and vfltiQiia, 






diaeasM ol the kldt^c}? may nccompAny thU *ULe. la this co«tt>ec6iM 
Tl Hof the uimoM Imiionvicc thai ji|)ociinrn>i>l urine be Kubnrtlltecl lit- 
<iacintl7 tQ the Mteoding |ihT>IiH&n uni.i thit thcM rcpfcaral Utt 94 hovn 
urincn and not thr inflfviilviAl lutp-liitJc^rtl «perinirti FmihenDocr, 
llic cucntul fcalun of Ihc cxaminatLan. v bdiattins tUncrr lo ibc 
putivnl, titK m tbc tnunotion ol iinnjirY ulidi. partirutotty of urvi- 
Tlns jwiiit \a afbm overlniJicri Ij}' llic i>iiicikliint:r, v\m may mi»tak<nly 
TVfivd the amouot ol sLbumln aa ihc impnrlarit fc4LUT<- 

NEPHRITIS,— These condiiiona ahoulil be conuck-r^J lo^iher, ittu- 
muf h AS the cau«tf« opcntiag to producr ih«iii arr fuctitljmy Idcnrkaln 
juiil luflher. beCftOK no line urt be dmvn beiwtai ftctoaL aoiic ncpli- 
ritii ftn<l uwn oonRnttoa. uvc that based tipon lb* dumtioa •! 
s^mplum*, MUd cou^Miuii uf (Ijc kidiury oMliL'uleriftl typcoccw» 
under mtaiy conditicMia of blifthl poti-nqr. uid b the ancitbtaiaoC ibc 
arvercr tvpci. the amount of urine bfirg iacr«iffi, b^i a nnaU iruc 
of albumin bcinjc preaentp and the uriruuy aotula bdnf actuallj c* afh 
pKucimaxcly nomal 

Btkalogic Factors.— Any atiilc icng&licai ami infUnnmtiuidcitt, tni- 
tMtg Prvfi-— ADUjEig these ivrc copcubo. cubcbi> MtidAl-wood dL 
rirprniinc omiharbici^ Ciirbnlir ndH, phmrtl cnmpnimdt geiwrallf, 
amialc* lead and nxxcury. Thcac csuae timiblr orily wbco ittfolcd £d 
cxofoiv* dosM^OT Cor coo long a porioil tn!<'itibi4 Vrimvy C^mOit 
■enti.— Unc odd. coldum oidak, c>«m, odd urates and |>ha»- 
phalci ftra the duef fi^elon. r«ri"<T-— These nuy be dividod bu? 
ibnc |r<"ip'- — (')' ThcBe xsudateij vrhh annr Erbrflf InWllonftanri 
Gvpedelly wjlh the eianiteniata and certain vimlcni troiptca] dbeasea 
of whtch yc^Wfivr trwcr U the M<4. {t). Supjiuntion with xpck 
obeoopticn. (5'tp Chronic diM-jLKA auch u jypbilu, goal, nialaiii. 
pulmonuy lulwrculMu, diabclct melliitu aadeenamof the an«nd«a 
Ntrvtnu Jn^umta-—li has brat ojitLotruiry lo place under ibU bod 
tbe nephritif attmdJnjE itucb ooidiuona U acuK mania* deliriov 
iremms nnil thr sn-ralled avcndlnji fir rHfn CTVigrtlkma o>nDf<1nl 
w^tb diM«M> of tbe bladder, Acmind rcmdea. uiethn and Hk pnaUK- 
llbfifobabklhiti tbiAfifn^rrPCt. tn many of the etueaM acute vanJi 
a tMphritU i* tJie anttcrdcnt factor of vthidi niai^U may be lint a sympxtm^ 
Is, delirium tremeiiiii the bobit^ oE the individual- the lib«IUiood of pir- 
ejudng dbciAc, the enpoxare and eibaij>Auin atiradins a debauch 
leave Jilllc rvona foi Ihe oMcr dMaiA«alion. In the cue of the w-cdkd 
K^ez or HatTndJa^ ij^gnikin. tavr in ihf rvtit iuuiicei, we aie |troC> 

HRjUKf Of tSK KiDmnr — Acm cotJcisnoN. 


^^RMHi. lb* UDcntfioct of lir^ quntrtJM of bil«, uid cxtratnf concni' ' 

I Qeat4l or pbyskol, portinilutr wtcn combined with exposure to cold 
or »Tl, would «i-m v% be ihv mail acdvp ctdiing rAiufiA, 

HorbLd AflAtOOtj- Tb< cnmpTcx dr^rription ond the vikrying 
lrni:Jnolo^y uurl hj tiiiltrpnx vri^m And invrftti^turv \fa<i to mu'^h 
CODftokm <iO tbv pAJt oE the student whra he aftriuuthcs the lub' 
jea vf lend pathology^ T3^« mdlj tweaiud bunc^r »botJd b« dearly 
bdd ia tnind. AQ rmuA Icniaiift. acute or dimntr-. fjiLl under three 
licad»: -^1^ Ttiffir in vrhUh giofHmJar dtaag^ ffoio'trirtoU. {i). 
Thnt im %^Uk ikf itiSfntirinl tk^niti tvf mfsl prtmitiaii. (3)- 
Thaat in v^i€h tfil ttrmiurr4 art alfcded wiitntut preii&mnam4t 0} any 
0Mf grtmf. ll miMt >lwa)v be borne in mind Ihal the finrr cluuScttion 
and sub-dtviuons a^ of latbolotpc intenart culy, &nd thcU in nnj inJlam- 
BiAtknof thekidDfy, Acvteoidirontc,cn« it lilEcly to find aI] bUuctnn* 
fnvnfved, w llul It bensmn tlmji^y a qkiEMilon of rvbiJlvi^ pnrdninlnfLEirr- 
In an •cole ncphrkU or KM:r7 acute conation of iht ki'iacy. dtbn 
gbmeruUr, lubulv or inEvncili*! dumge* tniy b« primoz) or predomi' 
QMiL With the docptloo of uulc aon-vuppartiivc intcntiliil ticpb- 
rilki tbe thite hmd^nuntftl tfruciUTN vc invglvcd, and in ani- event, no 
I d talol dJmbiafoTi can be mAt\t. WeordbiaHly Qml Hrmily ^wiillnxt 
^HfakluaaMtkfi. ocd bjnbce, drcpMol »nd falty drf^ncntiou cr toniplctc 



of Ihie «ptthdiuni oj the tubules whicb an truvnM with In- 
fhuamtttiorf ddniusk. We tit likdj to fisd acute inlra'capOkry sbmcni' 
UtM^tbecapiUarin being filled wtthceUtiadtbrombJ. tnd thcepiib«llurD 
of tbc lidt Bfid cafwlc briu^ inifoWrd. Tlic \ttllvi \b ^iuaiM >vj|Il 
blood cdb and t»iico<7t«a. and il wiU bo rtadily wen thxi tnUrfi^rctKr 
vfih rniol firtulation and nutrition, and lu^ep wtib ihr imnar)' Vdlumc 
b incnitabte, and fortkef thai the Iom of integrity on ibe pait ol Ibe 
fihiatios tppantu mtut MtXHuily Imd tA ibc empe cf olburnen. 
Id tofe hutancca a poitiuu only of liac Ddiicy Jiuy be JQioIveil, ai the 
proCEM may b« unUalenhl- Thr ^r^4S »pp«annc« of Ihc kidney vanea 
mjiDcivhal: il 11 ordinarij/ ivroLkci luitl red, drippifi); IjluoJ ou ttLliuu. 
hanng a auccattnt Fed, with an eondly stripped cap»u1e. Moit rardy 
t] nuybe pole and motitni ccudinj^on cfiirtiaii n milky l^uld (arufe non- 
aapjjuialiie mlcnutiid ncphnil?i). The {L&memli Arc uiunlly red and 
promlricnl, but may hr j^e and {r^diilinct. 

SjBiplomf. — He BjtQptomft Ynry 10 sennlT vith tbo lj|«of tbit'/Jwvdi^A- 
diMMS. Aa acute cnnpnliori may ^\t (ev oul^prGird t\if^. o^^ «'<^^ ^^S 


in:ntC4L Di,4r.>in7ac^ 






ocutie infinincn«lion ouj 6rat icnoonce iladf by uncnu'c oocmihioM or 
ctOTiA. One tS ihc bM ituii^n in thr irur of ntphntu ooo^rulng 
other d^KucN xA foLifii^ in Uk imUc irnAion. which u tlaaU ii 
increased in the pn«cnrc of eilbcr Mute iGnal]con|p«l£i>a<v 

GmcraJ Symptoms.— 1'!u: uiuci may be outklca vid frvik. 
<liiU and sharp Urapcniun rifie. or i1 cuy be gnMiaiJ And JnritlHMit, 
There U umnllj nun? pnia or hrAvinm in ihr loins and fiKTrttaed fie* 
<lueBcy of micturition, the puUe tduiom incrciK^* juid nouxia, TfrmSfhit, 
licft<kch« tnd thifv may b« poincnt. The brvcrrty nf \he EnUlal ^Mf>- 
tomflbtannoddtcitcxrlaiidn to UicijrpcolllicdiacascHUVOlbHtlboac 
of ftimj^U acul« corgcfilion arv orttinariLy nuJdrr and taarv r ii n niBOMf. 
Ic aumc invUiictt. Ilie find lUng noted U poffinrA under tW 
dcrdoprnful of Rcnenl cdcmA, or even uremic cotwulson* or 
As % njir. hftTO'fr ihrar la^i lypifftiimis o<njTnn!y afin wrrral itjiyicl 
Ulsofc ^nvr ii orJinuily pnAc»t> but ia xdilujr bi^li, uid !» oils 
fowkid by xhM of & priiaary dimM^ In ydlov ffvcr ihe nnpt fjinp 
lorm &it often iiu»t atnkint; and pfuninniE- Ti\t tdma of uuic 
ncphriiisBoEtcailuncsextrrmc. blikdy loLippcarticniAthecye'tidsud 
lEivnirA ri( xhe farr xnt\ Tht lilefn En i*hlir ;ui<l "piuiy." Ir itwcxtmrri- 
licA the snctlinif u 01:1m pantjvd) irm, iboui:h piUmj; deeply cm pnuuit 
tnd hfi.Ti\iiir of Ihe blup vvrining on thr tJrad ahhf backgroundp kottm 
Ictmcd "[iiorblc-Ukc" cdcino. ThcJc d a ftpcdal Icmkncy to kooqiIuj 
fomphcAtmfc spnplonvH tspmtJIy oifeclLag tbc laeroiu mcmbrMtc And 
the mytxardluin, Jind to «tiAck« el edema of l^c gbltb whidi aaj 
cau«c tuddrn death by suffooatian. 

SfMcfAl PrecAQtlOAa.— 'At leajit oncv daily the atlcnduig phyndtfi 
ahouJd br ca.rcM extxnimaticm cxdudc cndoorditi^ j&yocArdkk 
prricardiliK cmd ^Jfuriiy. with orvUhout diunon, ibc condition ktR 
nARwd dfieis ciiiiiif^K ^J" rapidly ^id iiiuiiioufJy^ Eidenia iii ihc |;hiub 
iLtuaUy demands immoilinLc frcouno to ihc moit radinl ouMum 
ttatr^jcatry imchmir^my bt'in); ihtf one umiiUy fouud neccBa^- A 
/nff nrPfKfTiJ) c>E iodecinon aad dcUy hu mgre tbar once faujcd dcMb 

Urinary Fiodfogt,— It ihould be unrlprviood that the uiiiury ftnd- 
inK> in acute cnnjfcslion vaiy with lu acvvnty bkit tend to awanK, fan 
pcisu, idcniicaJ i^hAiscterUtict, Severe iL<uie congrstion ran be (ii(te^ 
aitlalcd fium atulc ricpluitit uidy bj i!a ihurlcr dtualiut). b\A ibe mild- 
Dvtt of die tUi^blfr f^do» makes Ihcir rt^cu^tioo caay. The MudEM 
■bcmid refresh tiii memory ripga.rdirg ihr KEibject of albusmuiria mhI 
ihc ficdinfi^ and aixnifkancc of catu dip. ^14, j.m] befoic taking tip 
the fi^Loninjt Motion, The findings Uti nafuniLly under three head*: 



PUfi Sl^A. (5 Co I& <^y^) <'iuj<tfi'y fof u ^1^" io» 4«o cc. 
Ccvfii^: — du-k. iiDcikjr or black. Sfiftific Cmvitf. High or tiLiw. £.lbuiniA 
Buy noc it lo ioj&; iawublf \om if otbumin ia rcimovcd. Region. 
KdA, or Irum Ur^ quvuilitc of blood, ilighilf ftlkaUke, SeliAt. 
Abwhidy dtmlaiahcd. lucft i!it»ily diminUhcrf. chloifdo may be ftb* 
MRl U cliof^ be eEiKni«. ikdimmu AbundAol dark tcdfineRC. 
Out) ftbnniliot. tiark granular, rpithrtial trhrni-niH an4 blood fuu 
■jlh • fcrv hy«lui« and Cne icranuki- CuU carrying lfrUcoc)iC8. 
cmiuklt prfric rdliL wl round cdli fiwn «licet .'IfAHmin. i'l*^ 
KOafdins to dcfrcc ol luliU iaiolvcmenT. Rcil LWd ctlb ibuodAnC. 
kuooqrttt, brown graaolv rpilheful cdk, 

Sccood Sue*. — is li> t(j <bj^ UE moiiT-l /Inwiirti lJov-i5«iO cc 
C«4«r. darkp emoky. Spt^ific Otjviiy lorj-i^iQ. if«iwAt<<n- Acid, 
S«Wlt. SAiH dmunbhRL /ifrunrin H%- dimJskhJn^ |«ri pauii wllb 
urine hcwMC, Sfimi^L PiofnK and duk; ftlty duuige* cow «Yi- 
dmi u fntlj CACts and rtfiAl celU *nd mmpnunfl jc^nulr cvlU- Thp 
aiDoual of hi bdiota iaipiuvcinail ud mo&uics Uic sei'crity of 
priiQAry atUck. 

TItUd StHfe.— ConTalacenix. Edema if promt bciB nmr dfaap- 
pMfid, QtMttiij 1900-4000 cc. T«fldcQcr to polynrin. may loM 
ivcefe^ Cdlpr, fnteovdighdyttmokf ATmd^. Add. SpitifitGfWf' 
itf^ 1006-iMOL S^Bdi. Nonnel ui eligbllr incrcaacd by «t>»orptfon 
4iC ^Eudaiir. A^mtdn, Tnc* lo f^ of 1%, Stdimmi. Sc^C ligbl 
cnkr. abooinnal tilood cells (rinp) (ghutta). oa^uiimal liyalioc vid 
|[nniikJ fd^ ancl IJ^ht) cub. fkonobly nJi cpiibclial faliy <a fibiiaou* 
rtt«L A Tew zeoal odk- duax And rrrud crIU may CRrry fat droplda 
or alinoflbil blood odU. M impmrcmcnt canlinvca llic evidence of 
mcutr and rrfqenorarire chan^ diuppeuv and m^nc U ai kui nrvmal. 
Any dtcunk rcaal itiacuc may nhotr acutr or !»ubacuic ciacerbatlonA. 

ProgttOdM. — htm comncn and lea bul tu dry than in damp 
dJaoMMM, Childrai gvre kisie mtjiiallt>, j^/;^. cippdnUy Ksrlatiaa 
cases. Lov tCMon, nmk, icrau* cffdiion arc bad. Failure to 
Irnfirnvc ttHxa 10 dayA mean* hahOlry 10 <hfnn1r dlnav Fetnlstrm 
profound anemia ia a thicaEcniDg ttgo. Socovrrr inajr take place even 
aflfT oa«- or fwo y«ara. R^'Iapae and miUtiplf itJapsca fnquAt, 

An oBleoecknt aicute iJtphrUu, prolonged exp<iiurc lo wet ixad cold 
undn cDcidkionjt of fali^eur. chntnic vaai^irtal infrctini], Kyplill^, al(i>lio1' 
ii»,dtfOftk »u|>p(««t£on are Ibc common factora^ Mofbld AjuConaf t 
— 4^tMicru£itf. tubular and mlervdim changea are prewrAAW luv v^- ^ 


luuAlly tcnps ouJlj from (he ^« and taati\t4 kiJocy sorftce,' accboa 
fiiif«& inrxi^iucci nsUuiKc iiif^ Avwullr-n while coili^i with curioBstfcU 
of opodly. Hitr&K^pic FtnJin/ii, There trc okUlcfslivc byiliM 
ilfgrnf-rafivr rhangr^ in rhr vf«avU <ti (hrgliinicnili. InviJiPiiig boih tW 
cclb and the vMscL wa.[U and the tuiu show Bwcllicg aixl sqcIou pcD- 
Lifcnlion. Tberr ift a ii-ndency to connective liBue bgrowth Rnd 
proliuniliirn and JctctiLmuLlwa of the cafwralftt cpUbeltwn. Tbr 
lubuJo fhctw fte^^cnaratkni. dcfquARUliciii rtk! cwtrodtf of Ibcir ffpjtt^ 
iittfa ajiiL dh'ina stmI Cditnr-ttivc tifAur infiliratirMi i)f itic IntuMbd 

Symptonu^^ThiT gnwnl ijrmploin* tr^ wuallj fnnlc. prooouBOd 
umnia ADd cdcoui being prominent; ibe vnTioiu ucxmk pkcnomcM 
uv common and reruncni, thtrc bednj; a aprclal tendency lo hc^dadtrn 
ilyipepala. Intnuculik OMratgiu* muan, vomliinK and cliajrhcn. 
Plourisjr vid pcriauditb (u« common, nloention of \ht colon ocd- 
itfmnUf txcan. nnd ihnv U a mnManl Itvdency to incrrMe of Cffeon 
ind 1Q ccnvtal AnaMrcx T^ arcuioiory ^angp tit prmkoupccd. Ik 
pulw ton«joQ i« hi^t iho Hoimd Aortic nnd apical Ar»t aonnd nttrlodlf 
lOcenTuAlal iuJ ilic left vcnlrick h^pntropUlcd- 

Urinary Fiodiop^— li It outtoxunn- to srpanii* the urinaiys^p 
(ojm inTo ihMC of the fectite, u coni|iaivfi wiili the itioahe mm^^ 
it^-iUht thfinilkat lite juenM 4ymphfiu on Ae s*tmf undtr laih tt»- 
4i*iotu, ie,, a dtriM ottuMfaitf^p the pnaence of /«iiy <:a«l«, and 
nuuicd iiminitliifn of Uu urinory rpJids. The dmac is eopcdiltj 
liable lo subacute tuarcrbEitiont, f^vla^ lo the tirinaiy fiodtn^ n ntcm- 
Mflnre in in flfiilP nrphrilii of ihp ekrtv BtagP oi mnvalcatriict 

Active Stone. Amount, »oo Soo c.c. C*^- llijch or pale, ^tl 
loir or pronUh. oIUiq vmoky from caacvrbafEon. IfMdta. Add- 
Spaift Grtviiy, tligli fn>ni albumin. ic»j6-ro35. but tciuallj lo*. 
SiUids. Gnotly dimitii^hcd. eap«da]lv chJoridc* and urea aa in all 
dmp^itAl ijua of rcna] diwaic- AibunttK. TrcinendoiE^ Itibe matj 
boil 3£r\id. i *% (5^p hoA Iwn rvpiwicd. avicraj:e t%]. SeSimeat. 
Ahra^ (nnRSclrnthh\ hyallrw. ^nntar. fnny risnn, tuty eplibrlfum 
and compound gmouk cells. Epit^clid caaEa indicate vupttwUcd or 
recent or nibacuic bouhlc fm fiily t^rW*. fatty cryiiaK cfao l fOtftiB In 
htt aUgO. ditto waxy omx oftea rcil blocd vdU^ Inactttv Staff«. 
— Qtuniity Soo-ifoo, Caior. Pa]c or t;rrenifib- kfttctiott. Adder 
tieoiraL .Speti^ OraxHty 1010-1015. Satidt. Gmtly liimlnUkd, 
dlihcmf*. Luge. 11- SttHmrni. PracUeally u in octlvcttagc. 





ProBIUMis.— 11 the dbcaje b itrMHRlv intrenched uid not taerety 
a pfDmctcd cjuv of Rrelo Rrighi'R di)4Htu>H 11*= vfdinu rxrtij rrcmtf, 
tHil<liebftfT«vcan<ffpubuuUBO' Cecilia, prriuiil aiiuuia ur uncoiia, 
U>« at«rmgp dLjmiun i^ the c£Mace being a IJdle uver two ym& 

THE ShfALL WHITE KIDNEY,— This mrc ttinditiDii b lup' 
pevcd to rcprcvnt An advanced tUgD of nn twunuilly proloni^ 
chmnic parmchymftlriu* tiqihrilli wilh nltimaic pferiomin*nk?e c\1 i\p 
iMervtiiial clcmcnu. 

HorbU AfiAtoiDy.— Th« kidncj ia imali uu^ jtdknr. b«^u» of lh« 
icnainuc predominance of folljr dvtngi?, amnctliic tbsue hypnplnaui 
U iiuit<4i iht cApsatc be^cfE lliici uid adhrrcnt. ond thr kidn«ry surface 
utidiT ll rvugh and ervnuUr; on urtlan ihfTc (k inrrra^n] paUmniT!; 
ih^ onrtu u thin, pftk. yellow. Mid covered with fcnuwuilt, while apoUi. 
MUfMtafk HnUngi. Th« hitHMilUl chan^ arv marked, ihcre la 
ATtcria] tluck«nii}g, and the ^mcruLu nod tubult tnrucliifCQ nre 
<Wgnienied aad Ursvij datroycd. 

QmcnJ Symptoms.— Tbfse Atv ctscntlaUy ihe nme a^i in parcn* 
cfcjVtttou* ncptiriii^, <IiU)k<9 in the hc4rt and bbod vc»«U t>rin|; more 
proBouncfl nrtfury Ttti^fng»,^Qwnaiiy. Normal '-^r di^firly fn- 
dcaaeil C<»W> Talc. BtcOtan. Add or neutral. Spee^fic CrwUy* 
1004-ioia r<»*a(5*Krf*, Greitly dimiixiibcd A^mn. \ at t% or 
Iru, ..fcrfMwwf. Some as In ihrooic jhimiibymAti^^uA nejihuLb, avc 
ihat mtft arc loa abuEulant nnd Ihiic waxy cmu nrc f<>und in unusual 

CHROITIC IltTERSTnUL NEPHRITIS.- 4" Gouty'' kidney, 
"contraeled" \\')ntj. "dfrfiortic." "gianulAr;' "trlerotic" or "wnall 
led" kidnjcy, "cWnk rMoae^' ncphrili*, etc) 

Morbid AQAlomy.-'l'hc kidne^v .ire unull> ccuUh an mctancr 
havinj; i<nt tf^ftn^ti la whiih ihcir (vntbined wdghl wa* i J oz. The 
cspaule b Ihi^rkniMl and adbem I0 the dar% rod, nodulnr, jfruTMilar 
mflcc. and HXtkn ihinn vi ineirase In rvBiUattce. The artrrlni arv 
|ifi«auncQU the tottex vtry thin, the pyramiifa wasted and tlic pelvic 
fat intTeaicd. Sfi€ri3ttofi^4l Changtt. Thctc arr nscniially ihow of 
lunncviivF tiMUG uvcipuwOi. niLh atruplty Hnd dr^icaLEun uf both 
glofnani^ ajul tubular tirudunai Many of lh« gic^mpniEi and tubules 
ut oititrly clmiiuyRl. It ts hardly worth wMk to <tiiliTigui»h *a ar* 
Icrio-aclerotic kidoey from a live inlcniiliiil nephritis^ Is the lormerp 
the chanfe la primarily arterial, and the cnnrieriETP limiF than^v nnr 
kaa diffuae. but b bolh, ikvenermiloa, alrophy. and dcxnjciion of the 
e Ki ^t in g Kruciiarv ti tiic e w cp tial fniun. 




HxrarAi. raAdHCKTiL 








of Vcnui, Bftcdkiu&n^i Vgiran, iotm ihf pnouifr fnnon In cM»tfki& 
dNNigb U> ibb group may be adrlol Mara. Mincna uid MwiH>^ 
fit otiwr wvn]^ ovrr work, mental and phytiol, *]r|ih[ib^ semi 
iracnw. cxpMurp and prmaion, hmvy oftUotc mul Orinkins, aI plqrt 
pMmlocnt pvi, Arterio scIcrnMV u a prDmincAt fcBtuic ba CM9 
ol ffiimtitlfll nrpljrlrK and nnr Ih nni uirprlvd tn And vhii nrrau Ifty 
a ditrct hcrrdilAry uiilucnic m the dcrclcipmcnt vf Ihc UtLer i&kUc 
L,Ad poitoning, cbinnjc mAlafrt, ^lAit and liLtuiOkia, m 
anij prominent cAu»livc foctorv- Aj to tho c»e of uterio 
projicT. wcftnd »a.m|^cicfthcold jionjriR moru olJ by vinijc of 
vft&njUr vTAkrmfi or goulpor ihfougb sv^mJ cimnnL it^phltU, 
stvc mental si lain. 

0«n*r«l SymptomAtotog^r'— Thf ]>Al1or. fd«mjt *a<1 ihe fimiiUr 
albuniinoui nod cut fLLlcd orioe of chrome poicadLymaUnu nephd^ 
nmkc* mixtnkcn di«fCiio£i» utvpArdcAAble. but the mcr»e u Irac ■ 
chronic tnicnEltJitl n(<|>hr^lU. In the earUer vtMfF* ai tlic ilbraar * 
ptiicnC TAAy ofipt'ior to enjoy uniitiiAlly ipoud healib. ibis brin^partir 
ularly tru« of th« ^^Mj typr of llic diw»>f. P^kw. cdcvu. lad 
pigR^cntatLtin arc IaIc KTn7i>ioni9L. md the orinasy findiini ate san^ 
tinm both viu-i»bt? ^\d ohncjrr. Many caaca die ittitco^^tMl In 
many iiiufr, ibc (lU^uADt u iiwlc <mly a£ aviop«j «*il the varwA 
manifr«lation5of unanJamayafvcfbetfaccdtotheirlrsaiautfc- UmM 

Mff hhod vtiseh. v)d the uiinary cxAimnaiiaa denuu^d* cote and^l 
inteUi^ni applioaion of i full knovledpc of the vafuWs ol tki« latn^ 
uidlnary lilMuc. The ^eJir^aJ ^)f^lIJtolll» are casenlblly iIxbc «f 
VMmit* vhkb may b« pmfirvt at any ilmfi in any of ;u varkiua tanaft, 
or mat 1h^ |ioalpLiiin} i<) Ehc very tniluf Ehf uuc- <TIi03Ct1ionoaBnBBii 

iitf»bf<J u<ii/t I'lJt'AUA^ putit iTHtitm, as ttu^t^ied fry a>t gt^cT'fltliitf 
0* hyptrttafhied irft vnmrUlr. 4t kofit radiat fidtt, 4i*rf d fwrjtnJ aowt- 
iWultfrn el the ocrlU sntmd lit rtiiirol Jinf smmA wilfc cr wHk^iti 
Kotim. Edtfna. When marked edema appean in tUi dttcaaci 
usually due lo rardiai: fdltire. ind ihnw^ ihe chimctcriokst nf a paAdre 
coofEcstion cdcraa. the oioit depvndaxi pi>rucin being fM tfiTolvd 
M U (he Otfr In vnKutnr 6iK±m of Ifat heui. In mafiy c«ic« ol jatfr< 
«tLifjO ncpbriiU, however, one cuy«crtbccurinBfuOKe»oflJieeyc'tkk 
tapfdally the tower. prctteDliag in cbe nfeocving a Icnae 

piBUUxs 0> TTir tTONTv— iJFmwnau 




the ^k'ln b(in|[ tlutt, pcAflj. and almost traiuJuccnt wTiDc Ulcr ir tlir 
fl&y. the ttoui iniy hkvt t^sAppcu^ and Ihc delicate integument liih in 
fine ttrittkiA MuiT ol llic LSxa fiU uudci tlic Lrad uf a iiiiic^l lurpti- ' 
ritift. to bv J<i(fO><d fncHT fully later m, and in thcw Ibe tvnal facka is Mixd 
Ukrly CO br marv markrv! and tinmulaialib?, owing to ihr pmmcp of u 
parcnch]rT^i^u:t clcmcnL 

ChAngn in the Fnndiis.'-Ia ihcttr aa ft) other formE of renal i^s- 
c«Ar« tbe <7C diuijeo majr be pronoimccd and iinrjorlant. iii<]ecd. 
nujtj ca*c« V4 r*f«n«(l toy lb* omliit nmkt a ccm^cl diagnosut, 
wiiImhiI urinaiy cxainln&lian^ The tuoud duui^rt^ uinsisl of 
iUm« sh&prd hcmorrhai^e, papillitis, retinal cdwift, or |wcutiar lava 
cDloml (otdm. rwluting fmm ttv icimjia luiej. (Sec Fijf. i, Pfair 
Vn.) GUneoma C» not unL'^nninnii, and urmnic AmaurMia iixay <ic«ur. 
At a fite. ihevr eye <iLUi^ lodlcaie a fatal ii*mninitlj-;n in k «hort 
imioO. yd tbc Authi>i haa gtacncd one cox in wbjdi ihcctigmaJ 
diagwKis «^aa made by Ibc ocuU»t, and 4 subsequent glaucoroa led to 
aradmioo uf the alTected ey«; yd iKe jaiienE is scill living afler 
flnen ^tan m oppoteAt ^ccd beolth. 

Rt^dralory TfacL^Il b Important rn rrrru-mW Eh/* ^fwrial I^AhlHry 
of ftiMl ox* to aiiadiA of trcnchllia. pTeuriayn a^ttima, cdtroa uf the I'irurbi, 
gfelCiOAddytpBonin iu variom fArma. A pleurisy with larp; eSuiion 
any coroe on oo quietly u (o atttu:! no aticntkoi nvcthrouxbemLar- 
raMDMnt 10 rr*pdntiQii> In a com ncently obacfTed the acuic etfcma 
ai Ifir larynj^ed tiunrs thai finRnwrtl n f-harp artnrk {>f ifin^itllik, [imvf>it 
to be due I0 an acute conf^ton ^upcriinpoecd upon an old nqihriiis 
nf tbe art^rvfHiTrilic t)^if auociaied vith paiiive craigatioD. 

Urinary Fisdin^*— The eMcntial x^pmnaconaiait in the inemaed 
anouBl of miijhl ume. attended by increased froqucucyaf nttcturitionp 
a total bicraaae for the 74 hojn« a imdrTicj in (liniirniTiim En llir 
total anoiant of KiJida. U»ceaof albunim and afcvt hyaline and ^-nintilar 
tuttn IncmiNl night frnfiimoy may be dup Tn eauses other than 
ocpbritb. aodi » enkrged prostate, dironic iminbility of tlie ttcck of 
thf bladder, or eyvcilia. but irbm the lyaipiom t« oscocutied wilb a 
awfked duluiljantic of tbe nomioJ ial£i> between ni^lil and day. the 
aymptom becomes one «i primary imponanee. 

Dlmlnutloa of Solids. ^A man wilh Enier>lLiQ] ni-|J:riti^ may for 
ycacs posA, the greater part of tbe time, a normal amount of vrioary 
■cIkIl fn Ibr latter slagr of tlie dufoir it will almost invariably fall 
bckv nocmal. aad Ibb b o^ccially true of urea. Variable Infonnalion 
It <dtai ^VCB I7 ladilBa dfcifia In urra cxtretion and la 3> C3hbft uVbAti 6jDMt \ 

C'U 1LA, HC-^ 








Subaru If 
attack fc 


I ooal likd^ b«Iag llic UIH31 voiiJoi 
in Ibe middle of th^jdayorahw^diaovrolnijE^^ 

obBrrvaliun. il rs ofttrn poufiblr [o avitft ui Smpendtng arudE of nenaii 
thcough this wvnmf;- Alhumm. ,Ubunun nuy be praieiit omIkm- 
QUa^y or inttrmiltmtly. jii cnr time nf the dny and not jU vwUwr, bnl 
In uiicuii)|Ji(*lc^ (Mca wHI be fuunt] i^nly in lundl truxa. Tbe 
flwna L^ft*l tiUly 1oiht>wit»rt thofc i>4uc>(t m thctnrtyt&omfai|^ 

Ttml boun aftn* a (ull tamL Ukcd 
Boiih phytacnl eatr- 
llan and thf protcM l^f digntlon smn to !nrrrMeibi; albumin- Ana^ 
atmmdfn 0/ l^ fin; ^ j^i-imm, i-rrfi d/ A^f 34 h^vi MiMtf, fnrtvf ■* 
mam /nv J^mi ^Icrffi/ici nrphriiii C^or. Uiaiit^ pftki. Sptiift 
Gravity. Low. 100)^1014- Tiiidf flmcwnf 1000^4000 ex. H«T n"^ 
7900 orSoooc.c. fUaciian. Faintly uddn or ntutntl C/rraiarj 5#Ui. 
DiminishoJ. tclorfng mailer dimbbhni. cxtr{Ji indoty!, vrhidi u on' 
aUy incrcoAod, Aibumin, Usually a Xneu ntvly niches ) of t% ■ 
Oic later stages. 

8«4imeiiti— I'HuulIy »li|:ttL Casia arc diidly hyafine AnJ 'fatntli 
panulHr. A t«w rrnal cvlk may fc« louod- Sonvcucs atv atfod- 
alcd wiih cylindroid Kit>rnu- 

Symptoms of the TcrminoJ SUkc. There- rruiy Ic p«jin««M< 
^ijiih ilu^ rn ,1 Ifiiling h'-afT^ ns^iUing En an inrrTAsni ammmt af «lbe< 
miDtaad >aa nijEmorcnuincrodAcaaUihowiDj^coaiKricnuiQkaaadtfi 
arcationa] waay coM. The amcunl of urine is dlnuaishcd. the loul 
vUiU arc low, ihousti llic s|«\)fic Rniviiy may be rdative^ hi|^ 
The general apptaroncc of iJic palieni ui thai of a cardiac «d 

• it Is i-xiitmHy clEfljcuh in ib ariything fm s;ich a k%v- 

Profffioria.-No oac knows for bow Iooje a period tbc ittan^caof 

lEnlcnfitbl mrpbrilis may endure in the livlrig orpkanm. Il ia akk 
to iMfHunic iha.1 caif» lia«c laalcd for 40 or 50 jcaia. and thai tbc avcnir 
duration U l^n^. I'hruugh mhcriiancc of cu««> the aatbor haa b«n 
aMf to Ttillow jifltiii^nr^rlirou^ha krivvn period of atlcatf ^^ye^tra^ W 
lA prepared to bcliovD that Mm« of them will a<ld a cleodo aiocc bdoie 
thf? tnd mmif«. Cass nrr grealTy jn^wr^liiril by ibe ocrvirflice af 
subairutc attack* which may be aulBdc^lly arrtn to produrc aymp- 
tanifi of 3jjutr: conj^Htion. or ao mrld aa to chow liltk more than a lr« 
tichxl cells ui epilheliaJ tAsti^ The ocairrmcc of llie dtui^ b ibv 
bach-grouAcI of tho <y^ symptoma of airdijie incompcnsatioa and tbt 
apprsrante of may nun uinallv mean that the tetmina] aiagc hil 
bcca peached, 

cHHoinc DiFFOSE hkphwhs with wnmATiOH,- 

ThJ« <^iwA«(; rf i.'T\-K(ita (linically and jialhuloficailj a c>inibii;at»(t uf 

DtttJUEft or ntz xxpjtzt—TiJOAnvo uupcev. 



P&rpacbynutouB and Intntilrm (nrma, Ujirty *ucli cues ftre intt 
Willi m pnKticc- 

Etiology. — Thr cbusa art thocc ffvcn icir the iodiTiduol Iwion. 

Symptoraa.— rAtf gnmU lynpimu fflfr (Aoji' of tktomi inimtiHtii 
Hf^hriHj ^Hj d Hmv dt<id<i primary and krAinsI ^ifrtjtj, turi? 1 

Vnmij ¥iD4ingi, — QnjniiSy. Vsm]\y iiKTcucd, vjaiying from 1 
1500^3009 cc C«C«-. Pik or with > stight gr««oivli cut. jfMditvtH 
NcuubI or add Sfitcijk Graviijr. Frum 1004-IC15. TctA^ ScUdt.. 
Mvkttly dninsbcd. JJhmiff, Avcraice bcdrvco 1 and ^ of i^^. 
.sWfmntf, HfnUnr tAd ^niiUr cvu own? Etbunditni ihan In ordfnaTy 
ia1cn«itia) nq)bTflUi oed t^irfin/^ hi la rntAi in^Luicc*. occutonal 
finy nitt ut round, and in Advanrod 8tAgN w»iy cuu If will hv 
noted tttfi the 0yEnptui» ttiuu^huut arc thuae of pBTcnc}i)-nittODm jind • 
tnlcndtuil Dcphriti* b1«iidnl> ntd that ihty ccrmiwud accufixtely | 
(II t\H- ^MLi holnpf f dl dian^ea^ 1 

AMYLOID KlDHEY.-fV^ jAffMriiMO^^H^ fAi ii«i;ii<im^0AiM ' 
fr# wdf ifi thT4 diwur hut the prrwi(y< nf crxidltbru wiih vthkh it i» 
kixrwn to be ojwcUtcd. rix.:— jun^rloid dcgeocntion of aUi^r orgui>. 
usoiUy occiirnDfl in the pmence of chronic tuppuniion at otchctM, 
b iugfE<vihv. AitTirid »ilh a large aniocint of albumin, ky^tu ituh 
is ArUblo numbeni. aMocktcd ool liklrcc|u^iJj' wilh gnwular and 
ocaik«i4&T fatly anrf wajijr m^ii. f'nnsliTUtc The urinary findingH. ihe 
moM nsi^iEoukt ftthire ol vludi is thr tuust combiniLtiioc of pclyuria^ 

MOVABLB Arn> FLDATIIVG KmTfEY.-Thc nom.fLl bi.Jjiey 
mav or m^v not be pjtp!iT>tr, hui ujniftll}' lu lawer burdr^ nwy be 
chrtecled undn |iit>|vr ((.indiliuii* of muKiJur relatition nnd uomci 
lecbniq«c> To paJpale Uh Icidney, cxk himd ohould be placrd over Ttchn^u* 
Ihe flnaimg rihi brMnd the otlier below the tiHlal margin on ihe ooier i m->p' '*' 
aide of ihefeciiu in the iiMminiUarr line. ByMeadyfinnpTCMurt ibc' 
\trt> haiKli ibouid be &pjvoddaiate«l. »nd dunng full ixu>p{rattnn allov^cd 
to sepanic ati^lly wlicn lUz inov&bk liiJtivy Jimy be ft-]i Uf pa» 
bitn<fai Ifaam, iind may be diivctly «n^;ftj^ and pal(>atrd during Ihr 
WMtanYtv, So alicnifri abculJ be made lo gnap Uie kidiLey pnoumly, <'iuutih^ 
Wtd la anr rvFcL ii sboiild be cn^'nirvd betwren ibc tini^T? of itic two 
ttti>ds by limpic appnntmniian mthct than by any grflfii^mg nr dutfh- 
bg durcakCDl futb a« is »meiinn<« recommended ThouKh, orJi- 
naiily. inch an cumlnalSon ran >« carried out when the paliimt iB 
(n a Juraal jKniliua, U 19 ofieii u^Fiil Ui cumine them iu & \v]rvCu»<\'\ 


lUEoicAL puaxoaa. 

Mo V Jill t 






b«tire«a Iho dcowi and Iho btlrml. the ftrm <n the 

obMfTVBtian being aUr>vr«iJ lu liJiBg luuatl/ forward, t 

I ticnt racdnnc socnc suppcrt to kKctc \ho nbdomipal tnu 

iDegree* of Rea>] DU^«<«ivi«nt.'Thp pnlpibte kidiicy b 

' vvjjoac li)W?r ciSji[C iia Jul be felt Vy ihc cujniopcr. 5uili ft kidn 

not aboorrpal^ the n^ovjtblc kidnc; m ihAt which hUjh tftdt uid I 


linfEi^n ftbovc iu »upmor bori^r during full inapintioa^ TW 1 

I flfmclng kidney is ap[>lr(*ii to ihtiie bning moic than ft vtnksl 

I plnccmcni, or such u ate rcrtiullr diipUccoble lo ft Imtct IctcI I 

I ihf umbllicUL The rmnj;^ of mnbiUtj U oflrn nEr»Ardin»r7 m 

I KinHT inbUuiixa the kiJucy itiAy ix louud iii Lhc (iclvis^ 

Kciology. — Tha di«nM icaybe^xingenital. butUOTt&nmnlyftcqvi 
Ii in ioj matt cammcin in wntncn Uun \n men and imnt oficn obsei 
, m mullipam. About Ihrte fatirtta of Ibe cum occur od ihc ri|^ 
■ndmnboui AnF-»vr'nththccunditlonUd<nib1e^ ConKPnlul rrlftxa 
I oi tlir liKArncni^. it^ht la.doK aod r^xaled (ffqpujidti. the watfiici 
I the pcriuiTiFAj Ux of the op*ul«. Ifaumittani, BMicaltr atnio sndo 
■Dtged oiuitn rauftt be pkcsd in thf "nnl prmTn *' dftu Ii ffipmhi 
thftt in omny cajc* a conbintltoifk of thc»c caiucs nmy be cipottlUt. 
ruTii>LLH nrlniinnthlp hivmi bi cilct hcTwnrn m^viahlr kiihwj 
[ Bp^^nditilis the Iw-o <unditi<ma bcLn^; often ToincldcaL 

SymptODK-^Slrengi* lo ny cus ol exlrvn^itf morabiiity nujf 
'wilbout en; sjii]p(fim». while aUglit nucs Duy ouue the noM 
(eoK crises ind no jidcqunte cKplaiuilioix of Ihu fut h» <vtt b 
I given. Il Ik often wiu^ lo wirhMd InfnnnAifan fmm th« |«tj 
wbcft Ad ftyrt)('k>ni4 ncem h^ bcj^rrMnl. <^r where the cimililian 
indilrnmlty iir nAiiHlly pn^'nunifivr!, Whm vymptomi aft pM 
ihey vary from Lho*' of mild nciirft^tbcnift ant! tlyspcp^A in tlm noM 
ibltf criu-i fint druribpcl by UictL TA^^ ate aM4<ks tuJtUn im M 
dkonUtriiai byinrrt athhminnl ^iiin. rniusM, vcmitim£ jivd in trtn 
Ufo by ihilh ffwr. atui rvm tymfUrmi oj tiiiafte, I'he utiiMSt* 
should br olmtrvrd in {UagnMU. s* frrora are iMr>Titfh]t?gl7 rn«|«i 
In unc E;A*r cuoiiDi; under llie authored obMnntion. a rouag nnoiftil 
wnman liuil double Hoaling kidc«y. Sbe wt* lubjea lo ftltadti 
TLolcni pain referred t> ihe fe^ian vf the gJ^ll hbuidti. aaJ junudii 
With jbuachoe. A cotcd ftargoon waj so Ur muled aa to opoale 
UidlcijJLkMi wliliocit remit. In anolber cut, pndtdf ^Uv am 
occumd wilboui jaundicti^ and tlw e&ic w&» refcnvcl to a MiTfeon 
ft Caution oprtation- S>-inptan:Ls contmun] after opcrfcijon Mid 4. 






teqopTit inriiion wmM s pSl btxdtler fuU of Mooeft. In another 
{n?LtAncc a co^mtiac J^Jflm(Iidli5 vu found Id be ihc real mLinv o1 ' 
the piin. Tte uttboff rcmimt Ut expma the opinion, founded u^xm , 
vimiwHsir rxicrnhv fifipoftimity for nbvrvndon, ih^E int* tfUtI'% /titn iiirii-* 
«rv rr/a£iW; iw; a<»i /^ lA« d>^fnJaJ», X<>'' hUdda or z^irit i^ttr ^^* *^' 
«rtf inorr J/My Id hf nuntiiil ftuiaft. CKsn haTV htm rrpr^ncd in 
whlcb Uk odod^ticjb ti» been cudioiindcid with tnial ujticp bul tuch jui 
«mr should mUoco occur. The co etviriitc ol profound neurauhcniH 
and hyttt-rk oTten uioiplkaie ilic cxunmAlton, The MMK^tAririd of 
inoTtblc or llMitiDic kidney with ih« dUplocvnncnl ot oiticr Abdominal 

litis i> fncAAl in iTtlUniin:Lliijn crrnipicttly or chiciij' conhoed toXhit 
prlvli of thf- kidney. L/ pvcknit-i^ihiuU a^n ijtn4a]itiiaiiin invulvinii UitTi 
tbv kiibwy wbitonce And the ptlvw. Thelonncrcsnhvdly csiM vrith- 
4iut A «li^l inrBAion nf the kiilR«y kxiurr. Etiology.— Vnr»u<; 
miaiKir^auKDi an CApaLlc of cAuiinir Ihcac condiliom; Amonf[:sl thc«e 
W«:— llicpyojccnicBtirptooxti.ifaphyiottMxi- lyphuidAndcoloii bAcilli. 
g amHML Q «]id Iu1>i;(ilIg IJAuIli- lufcLlii^n ui tlicv iMfKi a luuiiliy ab- I 
ctmdm^ i1m bloddtr ^r unirr being (he pnmAry tource- Th^ nrny. 
bowmr. onr in uunneatiun with I'rrtaiA virulent Acijtr iiifrftitini. qt . 
in thcM of ihc <hronic »e^. nod urdcr thcw noaditian*. the uifcciivc 
•gent ivoutd •ppnr to b« brougfcl HinHl by thi? drmhiion. Rtnnl 
C4kuto b A poieni cmik, yd clones mAj cnil {or y«Ar» in a kidney 
wiihovi cAoilng sitj mAfked du«iirt»&ace, 

dympfacofl of PyeUtb.—An acute pyditb u u^iljeml in by fevcr- 
pui in iht hatk, or tcndcmoB in lb* rc^o;^ of U>« fwdUh rib, and usu 
Ally maikEdbyfaoincntcniciuJiikin^ ThetiriiLein«uif^ciu»UiIlniln- 
vhed b Amnunc, «ir hit^ AckUty. and canUiiu pu^ \n <juAniiiy. Thr 
pAin Fvm hi idmple »nppiir«tiTff pyrlitbL may he to vreiv as ba limu- Cslie^ 
Uie xokAl ojik (tec (lAKC 6i>. And may radLAlc in ific rmmc WAy to tbe 
lEiciitt. inmcT itdc of ihe tfai^h or Uflkk. ChiU And tcvrr nuy rjcrur 
Al Any [imf duriTig ilic tuurv of sn acute pmcca; lertaui ooat hare 
been nLtfAken for moUrioJ kwt oa lhi« MOSMnt- OccoaioiuJIy, the 
vnntf-r/if an affrciivl kidney hmarnn Hockcil. and rrrniiion on the 
pan of tbc unaound kidtic>' permila ihc cxcrttinn oi lurrmal unnc 
(rott tbe •ound tite So^ alao, man** of altlngy ptih and Jotiria may ' 
pniduoe obamiokift at the neck ^i ibe blztddcr and |>aii] siiriutaLng 
thai ol Uone in the bladder. The urinary BHimrnl tbons lArgt s-^itn^'M, 
quaatkia of pas. a tafbUr amount of liboi]- luuatly of the ^^^Atsx"^^ 


■HlllDa IfUCaiDUS. 





quantztv arid Iho ntort or ]ru chimcicii»tic rdU of Ihc rnul pthii 
(m figs. 135. 137). Ordinarily iw will find a}so a fcv rriul cidkud 
ftO occuIoqaI oat, tJnder psompi and cffid«nt trc&Uncnl tbcM ^nip* 
lonui Tmpidly vubude 90 thu In a prnoil vujiag trom m few dajt u 
iwtj or tlirtt wrecks, ah uiuximpllraird <ii»c nuj rccorcr. 

Symptomfl of PycIoneplmtu;.--l'h<4c arc vutnEidiy the tAXamm 
ihax oi p}diiu. UTC tijal [^ic aniuuiil tif (ma in uaoAlly girsuer nd 
■cdiment ihcfvn 4 decidedly gr?aTn numbir of rmil ckmoiC^ It 
ba nrtied ihni ibr rhoncivrUiiir finiurf? contJM nl (a), ^m 

tttmunti, i^,, CUTE, rtn^ Krtd pelvic cprihdium Thr pi<iura 

nmch obKurtil by tlic iiit^^ciKc of » tyftUtia in wtiitli c 

Duy b« ammuniACfil. and tbf tt^Ummt may bo ii«i prohuBe* oad ailh 

fturb prrdominviCF ai the cy&iiE: dcinrnt<( ah iu gmUy ampHoue tfaf 


RHKAL TUBERCULOSIS.— This orcun in two fnrmi, tbr rxMH 
miJiarjir «hi<.ii ;a ;iirfvl)' a i^nn ui 1 jpmcrftl tubcrciiJo«ia anj tbc m- 
oUvd ciutmu jrrHH whifh ii of jcrrac dfti;c«l intcrtM, Th« UtleT«ea' 
mEncci UKunlly as a miUofy nr tugcr nodule whidi urrdvngM* miKii 
Ihc nunc diftniec« » would occvr in other poriioii* ol |]i« boijr, 
Eiilirr liTif rir hnih kMnryi mny hr aff^rtrd )u;d ihi^ prticr«s frvqucoilf 
invoJ^^ca ihc whole urinary tract including ihc uroScniuJ Af^MnhBi 
DiflgDoaU-^Thf* rlid^utii miy be wiivoiely evy or cafpritio|ty 
obKurr, the dewlopmcut being In Mine oucs thit of a /noMJt 
I /iMf ^dJiJir pr pyhHtphnHs. in oibcn punning a blcoi 
'TO K}'inp4omK fnvr ihntr nf irdlAlfivi. /n Avry Mw dOrtiitiiii jjWirtf 
6c jfttm liT i^ (Tj^mj f<i n/Jm K<ond^iy itffftkJy Pack « IAa sftfmiit 
tcrd, UtHf, priJftau, a*J iK the f^maU ihf MHtHn amd ImAm, $0 fllta 
pcnuttent dpuria w^fhoiit sif^s <if bUddcr diatud^Ancc* 
«<C0un1 for the conditjcn n^iU oftcnttme« pmrt to be of 
origio. In nioAt ■.\AAi'h iTu^re w • tUgcbl ctcviuhio of icmpvTBtuR ud 
m n jioodly numl^K-r lubcrculiMb. pnaont or pul. or ml&cicni funOf 
butory i« mad? nirh^nt ^yrnpti^m^ jif Uthiaib my oo-exlA and caai< 
ptdc ibc picliux. The aSccttd kidney nay or m&y not be mcnvfak 
|uinunly mid in tomv inAts.ntts b«cainc< ffmlly «iiUr]^ sad Kodfly 
p&I)aibtc, 'J1>c ftuthor'a cxperkntc Iim imi berri Wiib aa to ivmil 
him to coLncidQ wiib th«of)ln(o&i wiprcwcd by tMncoJourbcalatf^ 
grcms ihnt Ibr lubrmrlciiu chAn^ lA of necnoity ft pr o grra al f» ltd 
ikitnictire one. In a oosuHknbk niimb^r of inMuioca of tt^'. 
inwivctncnt And wcnit wbldi pmsmL^d i double lubtrcubMB 

DttOJtc or T«t KOwcy— cvxTrm, 


•dvwiccd t9 lo forlwl openiioa the ]>cuccb» bu »huwn Ihc Nimc timil' 
e(K)r lo UTTct V « «■> oh«n obmved in th« lunpi. finally, tkt diag- 
iRffflj Mu' tUpatd uptm tkr /Ming of iJu luherdr badlU in thr vrin- 
a^ thrir JiScrmtUi ttMning by fr<tp<r vtrik^s. lxsJ it mua hf. frmem- 
AtTrtrf that ihty may bt Jtntrnd in urinfs akavHng M thr tii_^hlf^t ^iUf\ 
of #4u.* In Mine inaluicca the use of lubeiculin \s juMLfmblc uid aay 
be fi^ovied by an spfKoracice of the badlti in Che urine. 

Reiul Tutnore.— ^Thdr scDcnd duuiulcjutici have dniuly tjccn 
dmnbcd 00 pftK^ 331 and the rabjcct ia one for surgical nkther Ih&n 

HYDROIVEPHROSIS. Iktmilufn. &y hydronephnw is mrant 
xa ^vrr-a^cumubiLon or tirine. wtihm Iht kidnry and tottit jior- 
tko «f iU urtror. du« 10 obsiruoiDti. A pcrrirttnoe of ihu<oad:- 
ikn GUI- r«ull in a oonvrfVoQ af a kidney mto a larKc cyst Etiol- 
Ogj. — Tht cnntlfUon mAy hK? lemiiorfLry or, fx^ribirfit 
«r ioMnniticni. and k nay be cither conj^iLal or cJv« lo diacaac. 
Amon^ lh« caittM tre itriclur« of ihe urHtr ur ureihn. calculi, 
dotL A tvislcd tirelcr, nich oa oocunh m Aot-Iinjc kLIncy ; or ^m neoplasm 
in tbc jpFait&-iirma4y Itact. or inwl^fnjc tfmclur« in doAc relation tail. 
The londilkiD ia uxnmculy (rmipuidiy urn) iittcinultrul. Lut due tn 
meat [&>I4QCiG9 to tcniFK>rar7 torsion, pnt»ur« or rvmovabk 'j1>iI ruction. 

AClJTfi CYSTITIS. — Ktlolo^' ■ — An arule inflammiitu^n of Ihcmu- 
CQfiu as^mbranc of the hiaddct tnay be du* to injury or in^fntion from 
calculi, (orciirn ^Kxii«. w^undi ind the fntrodudtoo of toiindt, or may be 
•Mddaicd toitb urcilifiiis tiibcroiUi^, pvoolalllb or mctt tiiH^urc 
10 cold and wet. ^xiial exceu or lh« losntmU oF InlecUout dianuw^. 
dfrnptama.— Dpuria wiib intttauiR] frrquciicy und luaiktiJ lrD»niu!i 
are the chief tfjmptoms, th^fUgh p*in may be aevert and rxdiaie to the 
perineuni. tht pfasu. hyj>3gutnutn or tbighi; icvr^r lit iiKuolIy idight 
■Ad nay be abdcnl. The ttriK^ is kadI, strxmjEly acid, of variable. 
otnalVjr hlg^ ipedAc gmviiy and mntnlnn an appmiimaldy nnrmstl 
aaMUiit of ftcdidB^ albumin, bbud and pus in variable c|uarility. I1ic 
•adimeni croiaisEa of pua an*) blood c«1ls in ^uaality with much bbddrr 
crptthdrun air.l nuiEifTiius ruunri crtls. 

CUROHIC CYSTITIS.- This may remit from an acuK ait^^k cr 
inaj IfttidiMHly rfcrelop as The ft*t»lt of enUrjtrtt fmwtate. tfriCTtirp, ihr 
frequent wc of the cAthvter. iiifectEon from the £miuU {female) aiid ol 
D OMfH fvoa cbIcdII, giowifci or hibermbiu procna aHeding Lhf vlicut, 

I * In tvD ciua rrcfn'.ly ofivrved xhr luiac was dliuoac dear and tlic onVi 

^^ubjcetWc •} niptijin • aliaht dWftc im |ibjii wrtr |l\t Wli^xxi: j. 

I in tML 




Ltke trtry ether biUow, mm^Ur orpin, the chaAgu may be cilte 
alonk or hjpcnrophlr uitl In maayCMCS of InngfUmdbig UM-bUiUn 
b ]zr«*il^ <ontnctr<L ftnd t«nds lo b«orm]« EnmaUiJ wltb utiBurnitL 
SymptOiinA,— Thi-<ir art rhoa* r^f ili# fl<iitp fom. usuall; in i mWlf 
degree both M to tubjcctivc symplDms Mid uriaofy iia[Kticw<l>oQ|l>B 
llie bllcr hIioA U les likely (9 be pFPtcni m qujuitUyp t^d Um nteixin 
b more likely Co be AtkjtliQe ftodxhov ihe i^evacc of iberulaiilr sKeni' 
tmskonU. The volid* &r u»uatly tumcfrbAl dlmtnitbed. ihc Mdoiml 
wllL thaw triple (>b»«jifuiic and oFirn Ainmontum unie tfjatak u Ibr 
pmcDcV of an nlk&line Ttoction. 

Conunenl-— rt should in* noted ihti thcc* ewn hck tM eFideftce«4 
rcDftl iQvoIvtiacRt xnd ibat the Albumlnuhft present i* uatul)y \m dintl 
ppofkortion lo Itic blxid or pua from which il s derived. 

prevcintiiijt no tym\}i<jmt of slanc, utrictuix or i-nbr^ proslfttc ifcooU 
always mg^jat lubemilosJi. Il unuTty imraJTrH prinuJly ib^ tr^pne 
AAd the ureihfal orifiecs. Tht loainal Tokkft Mtd prosute sIvdU 
ahnyi be ezmlncd !or ooduUr lolUmtlonft tod w^^ dwiUd be ^w 
to remit iKTmutiba^^nk. Symptoms.^Tiit apjicaniKc ts tliai ol ■ 
Kven or mild dirvnk cyitiiUi with or wtlhout hemoniiAgev tut ■■»- 
daicfl uxu^ly with ncid urine. The clEa^notis ilqimck upon the Im^ 
f&K «l the tubercle bkcilli, an4 the u>c of the fptoocope. 

TCTMOVa OF THE BLADDER. Th?s« fall pm^p^ tsidtritt^ 
gicry Mid il need ooly be aud llial ridpiU^rmalA &ic die moot fnsqi 
uide from nmlignanl gnutbft of iii1vui<;ed o^, and that ttcy 
chfefly lytnptoira of chnmic c)^Litu nmdated wiih nuuked JDirrmit- 
tenl licriTiAtuHa- OcfnAionally bits of the ftrovrtha omr nppe^r in dv 
isdlmrnt. wgetht-r with Khn^U rif liihAiir Jind f^udatc rclU from ihe vltt 

of the RTOWlh, 

ACI;TE PR0$TATITI5.--Thlf may mult from tbr ttiD« evi«E» 
Lhfti Icftd to ui dcuie o^'ti* ^^^ ^ rtcognuoed br tLe smdtiiig, heal 
xad i«ndciTte«K of ;he gUnd, luvctdnttd with throbbios. pun bthefaMl 
Jind 1c|^ dyKLiriji and attiKtnnt ur^nc?. bnih rpcul and vodeml vith 
mAikcd tenonitis And IncreMC of [mla nElendlnfc Ibe end of «irin«tieiei- 
C»»i of thv pni^Tatfr eIucu may Ih: prpi^mt In itir cmllinmi tmd orea- 
AionoUy apcmutafoa. othcrwuK tbc urinarr P^^i'v reacmbkft a«uic 
cyvtilk. Compliutioili.— Pnvlatic abKCM mtj develop ud m «tt- 
a^ aaaoditcd wiib known sympAcmt of wejth and may cxinc mecbnn- 
i<nl retention of urim?. 

CHROinC PROSTATITIS.- TbUUfiiarffni|amtBladvmAdap> 


ja canncL-tkjo with dmokalljr cDltuirJ pravUCc but DOAy ftlw tcHaw 
»mt« Atlpcki or b« inciifcl with chronic postCfioT utMhritic. The 
sttodMtion or modified iTinptomi of ihr ^eutc form juoridiiinl wlih 
pftlpAblo hypcrtxopbjr or awdlinft of the prosutc and the sftnptoim 
tit ehumic tyiakU nakr ihr ilkf^ottft. 
Chronic Of«ibritit.— Need not be oouMcnd in tU« volume- 
mmCART CAIXUUJS-— Tliu mo«t oonmoDl^ occun fa the 
bhddcr ur vcimI peha but Mod«3 taaf ocaip> ihc urctci^ omJ vjjy In 
DtuDbcr from one to meal busdrcd, ani in »/c from 0. rocrt gmiu to 
tlul «f A Urise onuifc. Tlie^ Taty ^^Httly in form, uHuUy wvumJng 
tike aKtp« of the cfti^i? b wTiIdi th«y )ic utd oocavoD«% b«InK pol' 
Midi bjr aitritifiii mhm i4Pvm1 lir In mnrari. UHcoHit, lytitn ftnjf 
pbo^ifaalr prevent usual!} a Mnoolh mrfocc and Ihe calcium ovahvtc 
•lOBC ift lobiilate »nd rou^ (mulberry ciiccluf). Uric aciti and uraira 
wj tn colar Imin pole ydlnw to deep bruva. pbosptiAtk sLoicv Krc 
grmjtti or whrte. thoM «f caldum oxalate dtvp brown* ol cyitin. yd- 
lov. ScciloQ iboiild ahFftjn be made In ileirTmlnc the (HDttiUicnu tts 
jcrcnl conccDtric lartra mar be found. Aa to frrq^acy, uric acid Mtd 
umic tUatft prvilominaie. In all fonu th« urinjiry c«dimt»nT U ilktly 
to fundib nKgcttiTc fiodlnp durios ihc vlaffc of ttonc formatkin con- 
tuning iIm charMtciidtic oyiflala of uric add, ammonMun or lodium 
i««iB Of caldun ouJaic cir triple jihoipbaic cryvub. etc. ftcrordlng 
10 the nature oS the ptoccM. 

TmIs for UrliUfy CalcuU.^The omcenlnr layen should \jr sawrf] 
tlnou^ and 1cat> made fiocn ibc scraplngi of Iht diffrroil laycm and 
of Ibe powdertd nucleus. The foEbwinn table u lahcn from Dr. J. 
B- OKilcn't ailnilrahlc bonk^* 

1. Prdimiiiaiy Ezutuiutioxu— Heal on platkiun foil: 
AihvmiH=^ flunc wilti odor of humi \van. 
VrtaUaUtk^^A flame vrlih odor nf Mhrllx^ and l}mAitn 

JCy^n^n bloc flame with odor if 50,. 
X^tdhin am4 mrU and^^^tu vi:hou( a damp. 
AlUm^miiUs — alkaline residue soluble hi IT^O. 
Sartkf phM^hakx=k residue soluble in accdc add viJlAmrf efler- 
C^t£ii/m neJoh «id ioktum t^rhona^^^n nBidu< soluble ifi ac«tic 
Add wiA effervncffTKC- 
^ClinkaJ EiemJHalkifn ci the tJrinr ami Urloarf D^Aitiuiwx. \ 


mn^lCAt DIAGNOfilS. 

CaMum £dfiAiiHir=origlnal powder nlubl«< ia iwvfk scid vAI 

CdJt^vpw ^u;4ifjJtf := 4>rlgfnAl pnwHcr faiftriubte tai ftoedc jidd. 
5ifiM'^— rcsMuc liiK>lubli: in HCI, 
Atuf/ixiJi Tat }vr UtU .icuf,— Otf^oal portir4-BHO^ al 

tdib in-) umio. 

Otfj(inAl povder — HNO3 and cvaponie-i-KOM^vkiil 
color, which diMppm* on hntlns'^ uilc kdd Vinki iacnssa 

t> SjTbl^iDaljc Eiamiualiuii,— Pn[!H;iicc of trnc add abowfi by (1). 
Boil in HjOatid Slier 

A, Filimtc -1 tfCI- T^i flnnd a^^^^c^vtilR of uric Add- ftvrt 

b whitkm, Oncrnimlc 
CdJ^Hm iir«if^— nnc itriiji nf nnliitfiw 1 aniiitliwi ■MmiiMM (m 

lalc^cmLib cakitim oxalaic- ""^ 

^d^cfjiwm wrj/f-^oncdrLipoJ solution - NHjOH * N»,IIP04 

:=cfysj>]ii jjmmnn!<i.tnjiKnrtitim phnsphatr. 
Sodium HTtf/-— one drerp of mIuIIod *- Pl.CI(=»ftcr coacratn- 

tlng, pt]^ni of wilJo|^a?imr chloriile. 
Pointrium tank and dmmoaiMm «in>k=gnc dnap of aolutinn ^ 

Fl^Ct^'^dcKle^Abcclni of poLjuiiapJnltnic ch!orid« and vno> 

niitjiliEink chloride. 
P^iainHm t'nii^>— Hvaporstf «oIulion «nd I^eIc on mk<&. K» 

Miw * HCI - Pi 04 = poUi>i'ipljilfftic- rhiorifir 
A mmimium tV*ifr.— Evapomic iolulion and ignilc on mka. R» 

iduc — no cf^-srils with PLCl^. 

B, ronkm in^^ldjlc m 11,0. Aitd HCl 

Ct\U.ium trifhwrtfr^-^olublr w!lli rffffWRT-nc^ Ftlfct 1 KH4' 
OEI^prcdpiUtc of cnldum oxalntc, cilcfum phosphiUCv aiHl 
nrnmnnb-mivgnnEiim phntpHitt, Wuh. Coltmm AvuldAeT* 
insoluble m acrtk add, Frilet 4 unmciiituin okaIjUc Co filuilc. 
CitkiMm pkotphaU givc« f n^piutc oi caldum oxala1«. Filltf 
-rNH,OI] tu filtntc^-^prctijiiutc of ammonfa-imigneiiuni 

GLVC1JSUR1A. <Su|tar m tlw Unnc). C?i>iMf D^Mim U 1 
dlnlokl xRK Klynvniria o>ntj>ri>r« aII ixinitblmis tmdrr which ibc une 
o>nUJn< KrmpcfU|Eitr [clxioooc) in Bvifficicnl quAothr to ropOfMl lo Ik 




fljf(V»rM 4IM mfl 4kb«tks^ Sugtn of wiotu kintli mny be found ^rucAK- 
Iti (he uHne. but glumv U iht tvat c\t cxptc\M^ Inietnx in thr ph)ikUn. 
NotvttX arinc conulns il. a> tC dncA oltriimin, but not lo An ciCtnl that 
on pRvlure inj onfiwion In Hiniml wnrk ; knwf cny uHnr tfldf iiumj 
rafnr wAm iriMJL (HVijni»<c ^ mtlHvd^ k^rt tfC\>mmcndtd, Is affrtirrrrml 
FiBlbcnKOdv, g(ufiue or <leilPM< max appeal rilh^s ^tidttanly or 
bitdinitlcntly In the uiinc oF appjLrctxtl/ Ucolchy pcnuni juid au tharp 
ItiM 4c^AnU* the bcO-Lf^ £roEn Ihc palholoj^c ondiiioo, uvo th^t 
•oggMfKl hy SufipL vho nays thm All rj4H*4ifALIiinitr--ni[keof iwtiiSiMtrc. 
yU-; — i$l liio9c cwlf onlnJIcd (»Linplc ^lyi-tuuita), iiiii tbosc tbat arc 
ininctable (disbclo mrUiriia) Tht urinr of onr who lAkr« into a 
fAidng atfioiiiMfc jdiloiiidua oi luj^ quanij^ca oi gLu:a*c, a wvuiim 
reccntlf ddivercd. ot the rzuui vitb a. brain injury may tcmponuily 
raacftln wjev. Tlie *lcput bigh livEng ladivlJiial mnjr mry luch a 
coniliiion for BMury jnem (lipogcfik dUbcto) wllhout strioua tmpair' 
m4^( of bahb; but Ufa of iim^ «im« nt^Urs tc prirv* thf hetUpi nature 
ai ^ny gfvm MUf^ Glycojuiu may cniirtly disairpcoj foi Lon)[ ircnudi. 
only to ttcur. uid i>ot uifroqucatly to assume x inaLignjuit orm. 
Sudt pcrlodi i>( latcacy caaiuil be jusi^y ratintalcU, aii^ Uic teiy chuiiea 
tbot ftn EhHi|?:ic<] lor bvn%& glya»ari& are quite ci>mri->Tily uaou- 
jLlcd wilh llie drrckipmmt of diabc4a mdlitus. The fondiliutii unticr 
vhich 4fiibr((s dcvdopa ift in brief the folkmb^:— Arc,— It occura it 
all jiget* but rbiedy in the 6flti Kud xitlh decades, lu prognotit tt 
bvcTKly u iHe ave of ^ Individual. CliUdra rardy r«ovef« aitd in 
Uiem, the £ourM may be aiituni«hin^y acuU- Sax. — Zd^'/c of lh« caMa 
occui iu maka. Race — Cerluu raxui suffer );teaJy fiutu dlacu^he. In 
Tunis aad ui Malu lU ni^ii0ea ore coiB|MLiabL0totbopeot tubcKulcna 
in Eumpmn couniriA Tcok hownvr* «p|4lea chiefly to criyd«dlcn. 
Hebccwi arc opcdaAy Uablc to ilic ditcaae. An cnormouj Ucrea«e 
haa bam nai«l fn rfrtain diira dnHrg Ihe lut three (b^cades. In 
Danbb liltc* uid in t*;iru. fut csuunpic. iIjc luurlalEly ia aaid lu have 
quadnipWd during thai pariod. Due alkw&nce must, ol eoune, be 
nuwle for improved dia^oaik methink. Heitdity \% ^ery mjukcd. 
SdwUU reports that diobotca hat oecumd mi the blood relation* of 
99S of the 3tt5 Endfvuliuk ttho«e entn be ba^ mva;tigaird* fonrtaed 
caic) tuvtnjf t^ccn rcptirtctl iiit ouc furniU- Diet.— r)i^t£vc glycowrin 
U u»d«r erfUin fordiiikHfis i^uitt unimjMrtajil. Van Nounlen would 
pUce m dcTinilc tinul lo the amocmt of nifpir Umi ^hcmld b« duposed of 
widcff Domal condilioiia. without produdnic gjyu^t^ ajb^ *(^ivEydA\ 






tmisacAL vtAC,tttUit%. 





writen hftve suggMlod n (cM tmounC rvying from xoo (o 950 po^ 
thli to be tAkm It nnr lititng, and dn 1 futing «i«nAch. If sq^ Ihrn 
appnn In the urine, the inrlividuAl ii > juapccL II b au4 ifaftt In 
cues ibc sugar cjicreltd u nf the uunc variety at that te^atrd, 
cIm* — There call be uu tl*jvbl thai n jiUi iJivl. uMotutlcxt wJUi 
tAiy fanbiU Aii(] snat meDlol ailtviti', arc potfftC EMiOD Id 
Gout.— -^joui a distrni^tly isodaint uriih ifuibHa, tbuogh It b 
(bit Qie arlbnik form ui conipantiTdy benijtit. Jht tcasoQ fi 
an aaaodfitjon U evident. The samchMtnoi EifroAd hcredil&rycJeciHMF 
being prt«CQi b U^lh diaeaKa. [t should be notni bovcvcr. IhiA ibe 
OOAffmption of aJcuhd b not often a prvminrnt Ucior in tbe cuiMtin 
of PCljrniauriL Dtbeaitefl Autecedeut ot Compbeatiiig.— Aalilr fmn 
iboar TOcntioncd in the oj#Tiing parigmph, Rout. ttibcTCuk^ia afid 
nrphrllls arr n>nininnly aamkUitcI with dlabc^n. thr tvM latter Mig 
uaually KcumJ&iy cundiiiooi- Obenty.^A Iatkc nuonbrr of 
rics arc obew. and ibU lipogtnic fonn is nrdJcarily c-adljr co» 
and often Ltirablir, nererlbelmB. iiuuiy aian apT-^rrntty beoign 
outjset bvccrmc true diabeLc& PacLcr*«lic I>ifiea£« ao4 Sd 
the Spin^il Caid.— It b pnbahlf that atxnit nnc-iblrd of tb« 
of di&bcioa an paoHTNLtlG Ib onpn. SoIctmU of the cord ouiy be tx* 
ondarTF or primary, vnA ibe raUtioiuliip of thp two ^nditiona baa not 

bc«ti nunicirrrtly iruikcd out. 

Symptoma.—'J he vo c«ilrl "Uim P**," Polyum, Po^rpba^ p«l^- 
djpwAH reiimeni the rundamenUl ajmiiiuiina aa seen in a lyT&cal catt 
and the thirst und increa»vd Irtqutncy of urination aod ha^ 
of iirinr arr ii&iLaJty ilv Ar«i i^Titptnnit notlcfil. An MC M a i ^w 
baccD in QcnHr all advanced taacdv Rapid L>a of weight aad 
ia maffced in Imc diabetes and often prominmi in ibe bcflti|pt Ibfm 
TA« Skin. Tlie itVin U di)^. ecxema, }>at)t. cadiucidca an: connson and 
ffuxpvtic is ofticQ a terminal compljiiilion. Tk^ Ryt. Noure-retiidtk 
Lemi>rThA^ Hnd rai»rarE arr- ofun seea. MtLtdti, Beaidea pro- 
Qounocd itcakncea, muAcJc aarope an common in adwiccid 
Stxuel Of^tmt. Tmpoimee. amenorxtoia. pruritku vxlsw and 
occur «uid prcgnAnC viuincn aie tkcly Xa abort- Scrv^m Sytttm. 
Netinlu; bcmdacbe. mcciid irtiubilitp or depletion, drowaioai ot 
inaosnnk snay occur. Iiik csckcdLulm may dcKli^p. aiid In 50% od tk 
aevBTC cnv* tbe kn«c jorks an absent. iMn^u Pulmonvy lulxtCD- 
lotia \a a coramon temifiuJ tstxA. 

ConA.— Diabetic eonm may be the firrt itcogifge^ aymptvcs of tbc 
dCsfue, The suihor reeatia a caiiu] meeting 00 the streci wbkb led 



to tbr ETcr>p^]|i(in rif unMsprdcfl Ailvjitiirrl iliiilvtrfl ia i!ic infuDi rUM 
of ft Criai'l tht bnbc ^yui^ <k lev Iujud ^l?r in diabetic o^mi. In 
tbi» (Bse the brvath bad Ifae p^^ufiir arcimaEic ^wt^Ums prtsmt in all 
rtiri ol tliTralcttlng cnma Mid prtAtinicii U> \rc due lo ihc prctcnte of 
■inloac. Oibci prcxncinitury lYmplLims uv licadsictic. drawiincat, 
natsca, njmilifi)^ c^y^liinr-i un-1 r«[jiit iJijlnr. the i]i>i|>iiird ia a itdimli: 
ftir huBunv Ibc ttrni sccuraicty dMcribinic (he ^iftnplomi Con^tipalion 
b oA«n nunkrd anil Ihr vfrnpicnn of mild or itv^rr indigolLon. In 

■ctiul cooA xhe bnalhinfT f^f^y ^' ^^^ <>'^ t^ ^»t> sffl)>'^& Mpvt- 
Ackl Off Chvpit'Stokea. CtrtaiA cuf> ore chaiMcteritcd b^ [tfofnund 
uoDapae* and la other* «Ujdc lymtHaeoi sn pn^mlncnt^ The Bloods 
Brmwr'a UiE m*7 b« vtluablo 1q comt if for tny nuon & <pedin«n 
oC imiw i» niulUiiiulilr. Twowneara, opt of ^lialwlk blood> lEie oihn 
of nonud lifeod ore Eiode in the ordinorr vi^ncr Tbcy lire 6^d b>' 
hftit ud minnl for two nintiiei its i i% qqitcoun «a1utTon of oongo-Tnl. 
Thc diftbtiu: (mear remftint LinsuJncd or *hotr« ft pole t^r Krctnbh 
yd\cw. Thf ccntrol wncu of normsL blcod is Biftirkcd red, £f mcthy- 
Lenr blue ia uml Uic dinbrlk iEiir«r tako i ]rc1lofri>ili grtrn. Lkr tiumiJil 
blue. On the other hand, a soluiina of ItiebndL sc^rli^i tiatm the 
dbdaedc Anar vnripl ind dnn nnc AflTm ibr rmtmal hk^cKl, Thai.- 
bb»d rcactiMU may reveal a itlyccmla b the absence of jilycevuna. 

Tlia nrtaa^^ToKlqiianilty fnmaanl ih» amowl •ometinif^ rrj«h- 
in^ or CKDCiImf; ao.009 t-c. Tbc »peuiit Kniviiy u hi^. Ku^g fiom 
1030 19 1060. £HJB»r varie* trau a mere trace to S or 19% i4i exlTBtne 


Of (nicr'i 

Imporlajit Voriatiocia. ft must be mncmbered thai in j^yocAurin 
■a ia aihi^mlnn Hji the nhnonDnl mnsthiimi of ihr urine mny br [uTAtTy 
abacBl lor cocuidcnibic pcrioda, may be bchinc at <aic time of the 
daj aad prM«nt a! anoiher. and t^l it may be wlioUy removerl by 
oueful dieting and prosier mcdicatioij, thtM making it poaaibk for a 
f^yoomuk to paM a life iRSUfancc ewnimiinn^ Furthermore, fhf $p€- 
tifc grmlf is not ahnt^ high, ^mt\ n iprcinc gm^it; nf toio rirci nm 
Jmlify the oiaiMiIan of the lest for vugEir. as ia »o itcncr^jly bclicveiL 
No (Vir M the nrdinM sympTonw la abiolute. polyuiU Is not an inrjiri- 
able vjmtAom utd aa iiu^i be inferred boih polyphagia tuid polydypaia 
may b« absnt and even m inie di^wifv long pvri«dt of Lattnc^' may 
oaxa. The lesb Ibr sfUcu arc dealt witli lhi \ta^ 3jj. 

Piiureti^ Acid and Aeetone .^Scc page jj8. 

PtDgnosia. -'Ihv ^irnj^ntmn ^ glymurfa depmrU pHnmrDy iifnn . 
flic dedabw ai to vbethcr one b dealing wilb trie ^liaeAc:^ m '^^'^X 



u»i. ate- 



lliht utint- 



^jcoaura*- If llic fcrmicr, tbc ijmpmui i» aJway^ cnvc. if llic Ulftcr. 
ii favorable. In youth, the db»M U i)mo«t bvtriably tvptdlj 
cMsn. Ijcme cxlrcmclj rate- The UtiD cfct 4 Diort artioui 
Lhvi Lhc tot, 1 he prvftcncc oi diacdK: adt! U « cUa£cn>iu 
riLUn^ for pn^mpt mr-Asiin^ nf <'LimJn4tlLin KUrh il» vvitild br 
ihrcatCDinie; unL-miu, A)iri|dcxT, cvbondcs, tubcrcnlcob, j^ancrcoc aftJ 
ooma an diaAiDctly irrmirijil ^<rrT& 

DIABETES nisiPlDUS — Thb curiuLm uLucilL mxunug maaJij 
during iho Ent thrc« tkcidct <>l Ufc. ood mon fnquemljr ia Um RHkk 
may be Enduccd by Inumaiiun, viotcnt cinotkiti& aculc HhctWL nibcf- 
cuUnu perhonilb, niMUokc, ccnbnJ ayphilJA ftr lunaor. diMm d 
the abiVimin«t v1ic«n> indudlng Anfiiri^Tr, Hrnvldy \ft 
evident and il (UAy be ton^nllA]. Morbid A&atofliy.— The I 
o>n»i»t mnely of coDgvAion and diluluiicn of lh« ki^nry And ti 
aihl hypertrophy ct the bladder, ^'oiloua Icvi^ns of the acntwi f^Wfn 
have b<cn reported but nonespcd&c Symptotat. — LKceMivo llnnt 
Mrikini; omodjitkia and a dry skin ctxxbtL v Uh ihc ii»»aier of ei>onDoa» 
qubfililiosof p«le.fftin11y acidoT ncutnki nrine (<;cx>o to JO.000 cc) dor 
iaf[ the »4 houn. The ipcdfic gr»vt<y 11 eiirmiFly low (looi to looj) 
yd lhc tifUl »jlid» fui the 14 houri <ut £t?ai1/ muvAfcJ. um ofU» 
ocNdiog too gmd. Alhurnm and cbaUi tl pm«nt *t til tn Bcotit Mirf 
of no ugniliGuiic mii) ihr H^KtiH-ril is ur-j^ativc uriUinuily. 

DUI«rMitiftJ Diagnoflia.- The cListue u most cominonly coohued 
with tntmtilml nrphrids hue ihe miiinke c%ti wTdDm ocnir if ihd 
sulida arc tatinuilcd at fpltould iavuuibly he done; &n ^acicssc 
the rare ei^cjilioi) in the litier ducase, b urthcimon, tbe i^jSy 
vaBLul&i eyui;>CouLj» uf ncpliritU in &»> utsc likcty Ui be oanfaundnl 
vrith diabctm inaipiduft wouU bi- marked. 

PtiUjuoMtt.— Tli« ilcpcuda ui-c'iA ilw Liiuse uf iJie di)cue. Tf uvo- 
d4tcd with ccrcbml lumi^r or or^nk dbcuc in any part of tbe body 
it k bod- Miny ol the idio|uiihle auac« mxwer. 


KKAMiKAnOK Of TUB. Bu)CP.— HKDiatoLogy,— Thu rccnlly 4rr«I^ 
iilicd branch of mfidldoe hju pimvai inr-Unabic ut lh« tetMfitlta ud 
useful to the sm^CDon, Affording a mojju 0/ aevaI ^MfM*^ im m^xUnu. 
tht frnuttfwiu. jVofiuir. NU^tini /ny?, tyfikM )tt4T. Atiakc (Mtn 
MiJUi Inrr and lrfftintt99miMi4, /iw f d Wiwf j f mfcMcf r<i coiu i^ 
fimUwia amtmU, ^jUormi. fofmdctf^ di up w'i , Hfid^m's Jmmm 




monUs, ^^fmdialU, aftu injations. fricAiiHatir, Uad poisfmims. xcti*. 
mttkniffini and Mrfovi oucj u/ maii/i«artf dIuAiJc. Indeed l!kcw tfc 
bill ft pftft ol lh« Urge gri.-riip and tn idditlun one must cooaUlcr th* 
wivoUr inlormaUvm refratnttd by mt^tttwe fimlingi. Thuiuu](h U1m>- 
ratofy Inuainj; uid occufntr, painBlakini; work an awnti^ to sucnv 
ajtil nip^rfidid or iFiPxriic: knovrlf^dgr is of iJllIf! nJui^ 

ClinifAl E»«ntittU.— {a). Th< ikttrjfiin.itUrs sj hamoghbin. (t). 
XA* rM £fii toitot, (c>- Tk* vhUt nil touni. {A}. 1 kf rx^rAtnAhon 
d/ Intk NwJ. (ft). TJk tfjroHwrjJWn v/ JA« sm^r prtpt^tiUion (ft. 
liaNMrf, b, imMmtd). (r^ TA« riuijp o^ tk» varies Ul^mp*' w 
agglti M m t iiim nacHms in itrtain Mvk infniicna (smim dio^tLuus). 

QiaicAl Tests of 1«« IraftortoiiGe.— (a). Counting blood pbtca. 
(b), Ettimiii™ ot alkRlinily- (c). Crjowfipj- (d). Specific gmviiy 
ddonuMtiuD. {c>. Co«jcuI*4i^A pa{od, (f)> DciarmlnMiOD «l blood 
loluiici a^d nUo ci rorptiidi^ to plMmi.* 

Tbtdb ia Commofl XJM^—Anxvio. A dc^aency in coipuKla. 
cnlonng nallct. ot toul blood volume- OHf^otythrmw. A ddidcncy 
oi fpd crlLt OJJfMA»mwm»a A clr^rUnry \n tia:mi^gjinh\n Otli*fimit. 
Deadest bkx>d ToluoDC. ixa^fceyifitU. Tbc tctn Ia tommcAly lucd 
lodeaoi«in ibnonnjJincrnMin^niuitbvof knicocyittOw polymor- 
plumudfAr type pfcdominBling. The tTenge fier cable imUinacttfr b 
normikUf About 7.500L Lymf'kccykai$^ Ac unmuixJ incmH in the 
oumbtT of aioaonaclEttr leucocyin. I^ut4)p<eHui, The t:iii\jot^te of 
kucocytctttf and cttuivrJcal lo hypotttt^^KytfAu, PUlhvnx. A tcnn 
covtcii^ ¥rhAf VIA fontwrly cuppoird 10 br a [iLttholnglml rxindltlcin, 
now uacd lo intlidLc in inocuc m the loUi quAntilv ol blood, 
pktharic" u ^^)Lied to IboM iadlvrdunli niih u niddy 
due to diUtcd or unuuiiily promiDOLi u^jIHao ncLHurk. 
Tbo condilioD ti now ol lU^Eht diniaii imporiAncc, thou^^h it in certain 
Ihat then ia & direct relation of tJie blood volume, tii i\\t rniiaru lattice 
And the wc of the facAtt i'dlytf]i44tfmu> an >lin(>rmiLl tncrciuc in lli^ 
number cf it<t cell* majr. nrrly, he » iym|ilom of tmportajice. partini' 
Uuly when anodatcd wilb CAbir|[cxJ splccc and cyanoaU (Oiler's db- 
:) Off ACCtaoiJide iddictioii- 

*TUtvrtian ntiunlly rffiirii nor ^riT/ itirr ■uthcr'tjHnonj^l rTpFri«l» 
b«l 1^ mcluEq^ Lif Th^yrr, Smhin, CaUiTh Hrwr». DaCcara. YMng ani^ B. 
S W:>3d Kit cDmejnl t^ ihejr puUbhtd vurk. ui. In tbc c^kc 1^ itii? lirhL 
tour, b? pcnoiul inttruclMn ui cootiuLirucaliiTiu- S'cvrrilii'lrxa iIie |iLjLjli< 
eaiiutti of Hhilkiw GiawiUi SohK, T> Lucbot Heovcrt IJ4y<in, Diuhui\t 
Scon and ot^wn have becfl body oowutud. 

I Scoa 




Bmi Iiv 


Porm and 


Color 1iid«Z'— Ttir color Mvx nfitrtrWA lAft rrtnlt a^tatrnM ty 
dipidint Ik4 ksmo^obin pfntn40ig^ frjr lk$ pe nt m t ^ ^ »/ red crtti. i^ 
nonnal far hvmoKlobiTi being loo; and 5«oo^ooo. c«is in moi. tf 
4,5ut.L>ju in AftfTini. Lckic ibc asMiin^ciI iicjimjil fvi crytlinM^lcb * 

to ObUin Ulood tor Ectciintttion. - it ]« csBmUAl ih^ thr utml 
t«K:hiilt|ur shuuki he ihortvaflrAy Lindtmood. &nd IftirlU^rntV lod 
«xpeditjaujl)r aLme<I «ijt 

Precanlioiu.— On^ thnM noi tnut to th« flow of btood for ttvdE' 
jcAliun, The nu k-bc or the finger lip ihcpuld be aucfijly <3tttm4 
ffith jil«ihol- hiy T\im. colo^^, or some nmiUr mb«tuic* tJiwvji 
air4Uiiblr, &(id the ne*4k <tr Umri «>rJ itumid be skniitad m Af f«m. 
Ths paUmt shoUd he uktd vrkfthsr he Itietd* t4riiy ot ihe rvttneviiht 
ri«v of flrirrmining t}ic idit. dtf|ith r>i thr piundurr, and of KVoUbtg 
Krioo> (omplicittioiu la cdjc* od hcmophtlU. Two cB«tt ot Utb ksiJ 
m ihp suthnr't rllnic bled itcadll; for vvftnl houn froai a ttcy sdaaV 
ptmclure. For making the puiHturrui iiiMrumci^i friiha alivpajBaE 
pflgv »houT<I lie uwfl. Tht HagiLclom Qiftdto »n'l lh« vpring IhmM 
oifA a irucar pmtti.^ nrr niusl lUiliblr. the onlinAry iwdln bf^ 
j^wr iubsiiiuic* Thj? pun<:turr should be aaffidcAtly (n* and d«^ 
to obvinir r^itfv?ii*£ f>f ucrnnw jritthn. and fimhrmnore, ihir totfm- 
mcni IlHoiiItj br uAo:l with ii »harp, quick pninleM sItcIlc.J and Uk fini 
iwc> i>r thrr* drops »hnuM be fllironjfcL Tbff hJond »hnuVl flov ipM- 
tanojual]^ and to mAJiLtain il fi^AJ frktion iua|-bc uztcil.ivf ^nontftfMMv, 
i And lo (beck li firm ttcady pnanirc ifi niffideot, or b tlie caac of ttc 
^ An^r. vrriical t^]nMUin r^f ih^ Aim. 

C^r< and Prtparatlon of Slides and Co vtf -g toai e a . — All matoul 
abooUl be of \ht bt^r wn, { *(|uarr ;ivicr-f;biM« bein^ wufimor loAt 
mvad. sod botli thcv ind thr sUths ahuuki be Uin. When imJvd 
from the dealer. Ehry should be Ihorouf^y waabed in io«|> and mwait 
and Ibcn pUcnC in (be f<illt>winx jolutlon: — Hydiocbloric m id. i pOBi, 
absolute alcohol, tq paiti^ water 70 put*, or they may be placed b 
tolutfon mtitainlng ^iial |wn)i cf alo)hii!anilrthrT.|| Wbeii requinC 

* Evanpit 1 tn ij^wn com iIv hocm^lnbin ia 30^ , Thr r«d nib tuiW' 
I'-r>oi>o, r>r AoV ^^ dlvtdrrl by Ao M]iiAli A, a lew o^itiir iQil^i iik& 
C4tinir chbniAU. £ujm^ t, Hcnadobia io4t. trd 4^]Ih i,ooolooo « 
10 9- !□ divi^l'd }/} JQ chillis L,<^ a nl«ti cuknr Indci ajdi 4* J« found b 
p?TAldDU9 AEKtRiui. /^l^^PH^ I, UcmcfiJi^Un i;o*(.red<caB f «;oojOQd tf 
soft. <o divid<xr ' I. ii 1; oolor tndriE utdwalev MCoeHlary afur»iit 

* tllood nay l-t^ liiht-n jTum }^u(^ children tn lht> way without arnwfcn 

Ihrtn fn>m \ir*T-i 

Ij The rap^d cvAp»3ritEon cf the Uiicr rontfliuir* aa ot>ji M ioi> ta Iti «i& 



Fit. iti^—D\wi Hiie«r. 

xhvf abonU ht «if«d ihoraughJ)', pdiibed witb tisnuc fj^i^ci m wJili 

soft lliun, utd. If CDDVcnJcnc. psoMd through s flariK-, A ^raiLI ■Jr(rj> 

of blood vnll spmd MLisfulDrly aaJ rrcaJy bclToon » pofcctly dofto 

" ^ tilde uil fti oowT'gluft or bHwcnk two toTcr- 

^f^ft^S slifa.capedaltj if Uioe arc alighlly vrnnn. 

y ^?^^^\ Making th* Smww.— To mate i jiood tmcor 

AC T\^l iin;|KLfHtu<[i ilir ■■iv<7-(b« niuj^t ^ic Ab»»lmfly 

ciMO aod • ttA&ll drop only ahoiiid be ll^blly 
loutb^ by onr> C}if oihrr pliccd quidtly u]¥>[l 
it fla kuUAl oIL^ed for the »p4cad of Ihc btood wid ihc tnc xpomUd 
b]e ft didLag <qoi n lifting movemeat m thowc m 6^fur? 146 The 
CovcT'ihit slwulcl ntvcT touch tlic skJn. Anoihci fncitioil ^ixi^t^r^ ja 
uaii^ tikc cdgv ol «a« ovrar-^uo and diaving It lifehily Ktnw the 
dropi uioUicr ol a ilmflar jiraccdttn wkh micro- 
»npe tbdco and ia the tuo of the dgairtic paper 
Mftge u slunm la fig, 14B. A good fttuar tfiouid 
$kom tk$ cdU ^fmfy dUtr^attd Arouf AmiT lofii 
tmoi a»d tk^aid noi Icok h lA^ eye tmenry « 
ikiiikw M oicfully pmtiiKxl ike dry mulctmnf 

losi ught af br ih.t phyfticiAn Forcrpi 
att aol needed ax any VAfic of (he procedure bat the stained preparations 
are more brilllAni If thr »Up Lit tnimeitiaiHy drird civer a flane, 

FIxatica ol DrM Pr«pAntloil<— 'tlic almwt univrnal uk of lie 
U'rigtu stain laaLcv a pooloagrd dncriplion ol iti« older nethodn unnM- 
e^oaLiy^ For rapiJ woik with the lrii>lr ujiin ii 
^^>. u ffvficicnl mtiely to paa* the amcar throuj^ 

^^^'^X. ^ flame mpiclly jo or 40 Timn wUh the dean 
^^=^— ^ ftijirfaoc down, mufh a« j'n fixing ihr preparation 
fnr lEainlng tiiljCTck hacilli bui «lih mthtrlfju 
bait- Tbr simr rtsuhs may be ubraincd iy 
boiling apMuncna fcr a caitiuic in absolute 
ala>hnb hy fidn; by one vlnuie*! inuntnuoxi b i% nlmhrklir snlurirjn 
of lovmalinc; or by a fev wconds* axponire to formaline vApor- The 
older healing rneihoda arc dHlnue, m^Tilir for ^vd rrauira a vjireUI 
oTcn and an vA ^ctxta^iy fi^r ■^rijinaiy cJuiiod wuik. 
BmntiiAlioo ol tha Fre«h Blood.^Kmh blood u n^dtly cmninad 

■Spfcimeaa In tike —lhor'> poeiriiion 1ia>« •UiDrd i*<[l aiirr one «« «¥*■ 
luro ycai^ buL llm ii a Unv Ikilt, rv<«n| cffom lo itiia aam« ra y«m 
old mean peering fulik. 




■Aft' Vllfl twa lOl*! 


Fie iA-t;ta«'FUr 

linn UiA 





by aUowiflg A ftnuilL drop ia cprcbd evrnly nndcr t ptflfecUy 
COver'SlSp knd »lii1e. hoth <»r vhUh bair ti«ni jernlly wannnL It vv) 
ftfford informEitioD of the pnUti value in ngard ti> Uic fottowltf 

boid mavcmcnts if the utAgc is kept warm).* ii\. PUafiaiu juhjmbh 

Inrmaiiim. (g), /wrvujc 0/ yUWn- (li), /n^tcr^* p/ Mtuxf ^Cofvrr 

(k). C^ deformiiy. Nuckiircl m] orlla irv nol ia W dlulngoUitf 
by this mcUiod, iwd white it u possibk for no expert to oukc s rnif4 
; dJiFewcilfll coiuil of unnnlrtcd lcuoocyta.such a Mcp is Kldoai txcfsari 
tir aclvEaiiblT. Tlic jiroracc ol "Lluud du0l" tjj JurniodbmiUM b inv- 
ested by a rafaJ vibnijon of tbcse tfay bodies, which in aU protMbS^ 
curropuciJ tu rjUnidtrd tell graQuJcL By acallng the cd^ of ^ 
<ovrt4lip wiili a Utile rucllne one nay ptrscrrc the frcali apedsA 
for houri. 

Ssftndcfttioii of thfr SUlned Specimen. The «clccthc aSBatf 
shown by tbc \titferciit conttituuLis ot ihe celluUr dtmcots of the Waii 
hr ixiuhi Aiiiiiiic dyu niTanhi a rcaJy mrjin* nf cell diffcmuUiko. 
Tbc aniline dyes an divided into 3 fcroup* (a) &uiV, (b) lUii^ (c) fioMf. 
Ry iisirif' dvH <^f [he vnrluiiA tIahw In combfmtrton In a >in^j|>li 
iiDc auy ia a *icf^ ilep aiuin diCEcttalialion, The buic dyo, sod 
u methyl vfolvL D3«ibylcvi« bhi* «« b«m*iOJcyliD (chrainatki AaM 
act tbie£y vpon nudd^ Acid c[>c& n]th ta cosati. onoifcc G- or vU 
fuduiia are protcvplaim KtaJoa. while neutTol dyct ^reouliuiit from ibt 
mlituir nf nrld jmd htuJc mtnn m luilutinn) rolor hrauiffully th« "aa^- 
tropbilc" leraaulca of ihc lcucoc>1C4^ AH inodcn OKtboda of jtoaraf 
ihpftid npnn ihe rwf^gniikir nf thla RrWtivr affinity. 

SULiniiiC Solutions.— Vp to within n »hoit lime the CavoHlv blood 

itim wu Jvhriich'A Inadd or inple stnin. bui ihift hoi now ben dl*^ 

plRcei) by Wri^l'a modiliCflitioD of Jenncr't Kuln. an olkaUn* —f^ri'T 

' 4>( mvlhytaic blue, which not <4ily produce* bnuidfu) rtBuJt^ btfl 

I Bi i>n(r ;!¥« und if^tfit ihr !ipf<lmrn. thiit HIirinAEin^ iHt* koboricm 

□nd delicate htalini^ pn>c<» *?i ihc older method.^ 

I Wright's Modification of Louis Jetmar'a Stain.— Tbc siucWni 
loi fiTJkkiltkincE hod be>l pucchoje a solutiiiu ready nude tliruu^i 

O Bra^liioA aiu^nrjcnt ^ad ^ owilnu-iionB iireeedLn^ cietwtioa and cet 
vl*ath %Mfi hudly l>e tudfoandcd wiih true amoMid Sovt%caL 

fTbe M covin nixl hcrjnniutylin « coin and iBHhylnc blue niKttaei 
■fc quite out ot dale m eiinL«Al «yi:k. 




drus tuppfy ItooN* u the CovmijJa u somewhat comphir,* and !t ihouTd 

Teclulqoc of SulniAC.— (i>. Tlic ihlvt] but u^iJiKetJ smnr, corii- 
plvulf covrrvd witli tlic »um U trtl onv minuU^ (i), llim dtotillvd 
w«lrf b «ililcd to IIlc tlun ou the cavtT-»H|> drap by drop nitlU ti 
grewnuA mttsllk scum a^pe^s *m4 *fc* nM/^>4j jAji*' a rtddiih tint. 
(3). Aflrr iAfrr vmnnJVj the ttaiti ii tKOLhcd nf! with U'ATcr, tc>vinit ft 
puipUib apedncn, which u vtuM unli^ Hh fiXm i$ ytthwUh <»r pinJr, 
(4) gouty itrM b*lvnen ftll«r pApcr. And (5) mounted In b«l«4m. 

RMUItVf— The A(7pannct oJ the tuioua cdlulu dement b «a 
foUcHA^: — trylJiretyifj. Onnge or pink throu^out. ErythrohStuU 
»ho* litrji blue nudd, Mood-piaqua putjilr. owif cfjf jronuirj drcp 
purple, p^iym^phomkUat kmcccyht zUnn ItIac 01 tUc niir.lci, n^iJr^^ 
pM/f jMHNJfJ IIIac McflUfMlf ^f0«n^ pJnk. line hasiiphilf granulfj 
tt deep Ubic MAiOt fodcrjtf tnd such orgBALwni « malarinl pirftaitca 

EhrUcb'a THachI SiaJn.— The fcady mixod powdtr Tor mokbg 
iha lUin may be bouKbt o{ any iiipply druj^ house tad lite stu-JentOr 
prutblnivr nhnukl nm Aiimipr to mnk^ ihi* original:— Konnulft 
Ehilkli-BiofLdI powder i^. xr. Alcohol (d^fJirlc) i> ex. Dbtilkd 
wafer 6 c.C Til^y good rapid vroric may be done wtih a good Ihple 
alain in the abaence oi Wrighl'a iiaui, b^^ beating Hic mnr-ti uLicfully 
as in tbe atakiing od tubeidc bacilli and itniaing for jo vc,. waxhinic. 
drTteg and nouittlnf; (Cibcit). 0:Tierhcal iiKacloii mrthndr^^rr n\m ai 
link uacd thai a dcscriptbn b not deemed laocMaiy, Scotl ftaca hj 
a few iceondt' pipi^ire in fonnalint funrn Vrore Bppl>ing Jeniirr'v 
stais and ahown bcauiiful reaulti. 

HftDOgtobiil,— llftmaglobtn or more pf^opcriy eo^hftmoglobm eDo- 
■iitiila^ alKMiC 9-10 of the bulk of the ivd OQfpuadoL Tl i% a jinjieid 
wbtfanec coniaining 4% of hnnocbreniogea. an iron holdinj; bndy, 
and gO^ of conrvntrBUd, ahnosi frLsnluble albuitiln v>hii:A rtaJily 

*F<jtmmia. — ta) MakeaCS^ nqumia lolmion of lodJum blcar'bonaie. 

EbHf hi Rrlnifucvfr plMur, wM >^ of OiUlHrr'k nwdJUiial oieth^lrrie 
tuc; piKc In iifun 9tfrili»r for an hour. (b'l. Aftci cooUnKi «dd vtiilc 
tllnine wilh cbu rod, « 1 tooo B<|ue<'id fotdiion of ClruMrr'r vtatTT-aobblc 
TfUo'vsh vttm «atif tEe eol«rr of the onj^naT tnittunr fhjintcnf to purpla 
■ad pfcaenu 4 hHVoua ycUovinJt vum upon LU turf d<«. <A boul ^ u mucft 
eona aolutioa v inrthvktae hlup idlulicn ^ili Ije rmjml ru-n>oary ) (c), 
Cofieci lUi arum I9 umnibc, dry ri ntvl vllh II ummir mrThyl nicohol. 
(ion €.c. of the Latter «DL iSnidrr af* hiE iV 'jf n (Tmm of ihr dry fircdpi- 
iBtr)* (d)» FlMnaeid add >5S of torthvlalcoh-A Thr siairi ibri>wr«afBF 
for mc iiflJ AaM meMm ptdp^ki n» j^i^ imfiHrment lUa»ih U0 fof 

Hi0id tad 


I fonns Amitohte ampimtid$ «4ib oof"- The gmi vikw of Its drirr 

I mJnatioD by rliniol UaU may bo Rwlil^ appivdAtal. 

I ToriB for HtfmogloUlL — An ^xprrt r^^rnvr cdM «Mtitf d d««r alt 

Hkjff t^y ^ ptTctnltx^ <'f hirmc£l*tbiti fnm the ap^ca/onet 9/ lUW grrfkaT 

j'dwn^ or rtvir Ihr uniiatnf4 twrtir pripar*itkn tts iru^ b« nttditjr spfv^ 

c<LI uf Lhlurutit «ni] «1hj flic t^iilhilvtfU-kii jiiiij mftiVnT tfliitUv* b Afc mtt^ ** 
tififnlrlaiit Jiuma (A itfirntAhlaKT and nrvalnhlMi aLk ipptUr) Sttinr4 

cialfd by rrftrrinjr to ^n 14^ but for iccurate irork srrcral focRi 
of nppflratus hivr bm drrkr<l, oif dipfwujittg ttjoH il CMt^timiM ^ 
a pvm j^iWfi oj Mt^ocf, nJA^ itihcU or in a iMTirK dtfrce cf JAdiat. 
iMifc {| fixed colttr iCck. 

TallqvJsl'ft HfviLoelobiilometei.- -THia, IhcAmplnl of ^ppuiM 
cooikU of liih{>graph^ Color bdnd*. i*arh with ft entnl pcrfdntk^ 
uul l e p re w rni thr color nf blooil m iJilutiunt runiung from ic^ Do 
MiniuJ* nhcn appLicJ to ibftoilxnl ]iaptfT> A drop of the paticai^ 

* Tbc color Mjjc i* bcnind wLtli w ahcd* of ipccUl paprr nuJi diviwyr 
into EbrM pwtit farniat^njc nuitri«r lor 15^ t«n^ 

exAiOMAnoof or nix dlood— itxMonu>uiNouKTCits. 


blood ]a lAkru op by the A^turbeni paper and tbc naultinf suln b 
placed uc-ckr thic ctotnl perforation of the cobrbtntls aod comparioon 
ii ma.f|p df mm at iki ti^n has t^$t iU wrt ^ss. n<A kfirr coni;i1«tr 
dixinjE- 'HiUUtftnifJt- itiMdliuti^kOfLurHlcinelhodalloiibEpi^dMbly 
to% vtriatkni. ui^l lh« c»1cr tti3t faikv. if ocm k«pt from ttic light, It 
ts iti^ttiittlv inferior xa Dime's insUurnrni mlLiLh uku lisr^tly a minute 
cnorv of time. 

Daf«*t HcoMgloMnDnieter.— A drrnlftr Hiic of ilntcil ^us. np* 
re^cfiliiijt iruiBlIfliu in bLjoti culorinjc ni^i«r of & Wnown dcfcrcCi b 
bhragbt inio drie<t fo'^T^tf by utnawktKd <«ivrlk Ijghi wlUi a film 

na^ifA-I'ur'tfevmOdpiMMmrirT. <.' UTr*er- 

oi the trrah nhtile blrKxI drawn by caF^Afj aiimclian betwoeu twu 
IJM» plftlc4. one bmrupATTCtt ihc oih«r tmulucval and vhite. A 
fbit^feAhlr obH*rTMdrm t»br vtA a dmiljir shirXil. pro:rrt ihr rjvs fmm 
caXiVMoua liicht. aad the ptjttata^ d hjcmoctobia mj)> be read d^rtdly 
fiQia tht scoJe. Tbr in^irtinx^i m^^ Si^ uahI in dayljght. t>m sbould 
be pointed M «inic daik ubjcU an<l rU tcAdiDgft RTC POt A^cctcd bj ao 
rtofii of Icuoocytts, 

Voo FletnthPA HienitiglobLnameter.^THii ndl k iLoiin iriMmmetit 
or Et» taott ftccunle modfficnUon ho» bcoi lari^ly iupcKcd^\/f ^'' 



>iTnf^«r and cheaper Irutrvmem of Due. If it k used octe sfatMild pr> 
cure Miculici'» mixllfic»ili^n. Tlit fullowbf pftantwofl mv nemw? 
Co jpH>d rcfluLui: — [a], J'Ji« rj/uiiijry luGtft fof laifaif tho <]rop OMRtf ^ 
aAfcJ!it/f^ ^iUii uiil ohuiilil be luitrd out for equality of oUibnte 
vhcn puiduLardn ih). AltliUod ntuti btftnuvpifrvmth€jMr}inrhtk>n 
mliinj;. Ca7ii««; (k^ naStbre fxattly fittrd. (r). Tk$ MmJ hiuiJ bd $jla 
qnKiiy, Vf<tshe4 ohI trih Ihe chan^Kr, and th-^tfVihiy mtxr^ in ik^ fkttt 
ess pessitit: iime^ (d), Tkt ebsfwtrr jkattid ta£4 0u nttf <■/ Ah^i 


Pit- III— Von Fltlvhr* UcnaolablO' 

mutta • EiriLEu vti» H<«lifE umtcf iht. 
nt#ii mrril aitr* ^urmihiumi i«y .lottuv 

from ihr ti]i:t\jfn hilphirr r<n?cTir« ifiu 

|]*]C*r. nUtDl t\y€ iimt cliDnj>icrL* htt^if 
wiih ^^hllnl 4iiifi knruwlileh i\ ttlrrtil 
I ha binrpit fnnHnnf'! ii* l^r rnativinr^ 
caiiifkr r ;itptii4. Die ucTiti (inniAirivunl) 
plAtn vaivr htii rprru«> Jtt livrit rFnin jhf 
cnk-rt-l widttc. Itv (novmc Tbc ndfc 
bjfV *iiiJ fi'nlb rhr turn** ai'- riL4[vM-T ipil 

■■<''' ' I ' Mr«ni«k Vf* 

coll.. 'ni GkevKv 

(itpi|tdiikii - .■> i B^ 

Itilicn ^1 r I" r »i (4- 

Iftn**] |i) > 1114 

E-<»liitfl* ir( 4^uint^ ^ siic' 
iliB AnEJ wndcv caHBiiiMHitijk 

Mbf ikduU ^ ma4t ifmckty ic> ftvotil unnruiniy Mtd cflnhirflML <rV 
FAtf 'AwrtA Jftrttv shoM U tharply tam^t in ifftter to tthtoim At vhid i 
cmfrujl oj PfTUfbtt until tlic final mAlch ol rotor b aclucvTil- Cc' 
^A'^vM fibf Mmi JofttriM ^^^Arr JnrAtff dfli hdc proprr raitir. as la ikt 

kjOfClt. (h), K'Afw Mf AfWf;o6i4 is tuUv y^ dtw^ #r trf^ 

wxxKTsxrtcw or -na vtooiT»-<*iiooD cCLU. 



iWdcd praporlionatdy. (i). Tttt miminaHim skoviii he Wink in a 
dbfil rc^m, Pf hy mt^m aj a tight pfv^j box ohJ in any tt$t somi form 
0/ Jtofitf skcM ht mid Jar dammiUti. ■ limplr roB <t{ blnck ^itt bring 
ostlinufly auffickni. 
H«m<ig:1obh Earlnuilon by Sptrtric Gravity,— By the usf or 

labia tu be luund in all tlir^ UiVCT vroii» 
cinJiDfc villi ifau fab]«cl itt hJsnoglobin 
[imf ni in « ]£ivcn vpcdincti may br \tiy 
-.iCKMTtLic^ tttiuuitd br HammcnchlaL^A 
:^uytiifmi]nn tA Raft mcfhnri Thi* pfO- 
• i'itin » too cumbcrsfitnc tfn\ fu&y to br 
rvrommCT^dcd ta ibc pnciiUoBtr >n<1 wLU not 
be docribfd. 

01jv«f*t H*iD0g:T0bilk6iu«Mf .^A&iliown 
by I'lK- 15' thJ^ ^nMrumcni ilepcnf]« uiii:in 
tlic »nJc <>f (ri]»i% hflivd Lipon dilutcii blooil, 

Snun «ad il baa do ftdvviu^ orvr Ihc two 

prrcc^iniij rm-thcMlt 

Gower's UtfriiioclobuoRictieT.— Thi» 
liukc iruirumcni hta the mrnt of exirrmr 
5iiii|illtiiy. Hi ill pranlwmr rnjty lr**r nmw 
tiirc by tii» mr thar wilh Ibr otlur more 
rlubnmTr frnTnimmtt. inMmuch sa n sJighl 
tm>r in dilutiori mrana a rcpcution of ihc 
wtiolr proc^ii. 

Sfthli** natinoclotnnometcr.—ThiA nd- 
tiiir^k insiniinenl rwmbl(» Uosvct'* hicm- 
i»m<irf tniilAttw'brMof ailformiifoiactTiraif 

nVfk . The Omply !:raS¥4t«4 tube U flfttld to ^n riPek 

*«« >t»-»viri*h«RwTiEj(iiii'tht mark to wiih a fTrdnomial Mlution of l»*»i »n*in* 
IICl whidt i> HlnmtCfS with cbldfofotm, 
TW blood tt Iheo added by mmnt of a mmcuting pipette ind the 
miiturc made wmpldt. Kinalfy diitlllcd vaicr U «ddcd until IIjc 
cobr conMpood» to that <4 th* control ivba- 
Thr cTjtor mrnparbnn h rrmarfablj nay ani\ rlefinilr. 
The in*1nnn«nt ihocld be kept !n it) cvc or m a daric place^ 


Th« R«d BUwd Cell.— l-:3di cubic mflUmtter af bum^i^^Vx^ \Viw:^\ 






■(n nt- 





Ci»ftl«in from 4,500,000 li> 5.000,000 (tjihroqia. iht iormer itunbn 
reprocQluis liic avenge Ivi Ihc female; the ktlcr ihM oS ilic male, 
A Quctualicn of hxM « million c«1Ja mfty be uiunvd fti wtthin iXiEOuJ 
limiU- The avna^ sine ol iht^ac ullv i) 7.;^ but a widv 
pOMihlc (65/1 lo S,5;i)^ Uvilcf patholopaJ conditioiw 000 
m«ri nith rjrjr/n/J^ largt or rx»Kmriy smaU itlSs. tnii vriih »in7rtld 
aylhriKylrj {eryihfMuh). 

GasstfiCAtiOB ol LeucocytK,— 'l~he idriplcM mo<lm <tac«McMk<» 
deals with »it >^nclk»:— (i> Thr fi4yrrtcrfih^imtltat maiinfkAi 
which ocmsiilvi« Irom 60-75%. (*)- '^ '"*''' tyjnfhMjftt (lo-jo?;,*. 
Cj). rA« iargr tymfhitcyks. wad U3 1^ ln»u>l»imdf larms <4-fl%L 
[5), fiwifW^WfS (0.5 5%). (6). BwpkU^s (0.5%), 

(t). The p<?Jjt)vr^A<Hiwiiv>r iiMlrapUIr crll tncfljtiiRX 7-5*>';t and 
LB dittnctcriMd by Eu irKpilkr. cTjirk bl'oe >UliiJnf[ nudei, oflco ooa- 
OGCivd bf dironsatin AnntUn vul th« prf«tii<« nf ncuirophiUc givivks. 
laking a lUac or pbk color with Wti^t*9 otsio. (1), TW nutf 
lympkocyk. This conUini a ijn^fr round d«q3 lUlning nudciu alsMMt 
fililn^ ihc ivU anil infcrn i:itiiu~urlii|^ iltr Uirdcr of |iiniopIa]on- It 
measuTO) S^iopi. I3)' '^'^ '^'j:' lymph^yH. Thb meamca 
Kid drnM a rounH or ovnL pair LkUip tuiring niidmi aiMl a 
lanic aoiouAi ci protoplum. It diflen from the InosilifKuJ leucociie 
only in iu Indented civ«c*ntk or rtcifbrm nudeiu, (5^. T^aMa- 
ppMJcf CA~ii;i) arc iqkUIv rcniRniacd by ihcti cuanr, Rxn- o4oRd 
f^tiultt and polymArphMiadear lypo. (A), B^sofkikt. (7,5-it^^ 
Thp dialinguiHhing Taiurr of the haar^lillc crll U ha fine dnpbbr 
BFUiulu* llic nudrui is polymorplu>u9 and sbina a dull bhie. Tbc 
cburacieHftic granule* arc bm ihovn by Wrist's tiain and not ji 
all by i\\t Irjpic slain- 

DnucuaJ or Abnormal Fonnt. - i kt mythcyki. 'ihtm kuoocylc* 
nay i.>mijiiij dilier riritlmpMlk ur r<«iniiphi1Ec iTaiiulra nvutiimiDg 
Iwo »ult varivlit*^ Th« nucWu5 19 sphciical or <nal. tnub lo be ccccft- 
Inc. s^aJnx fif^bly Vp-fih th(^ bitjr, MaLsionaUy fbowi divuion and nftfn 
shows a mar^nal t:}thl drdc, Tj^t ^nena »} tk< xf^snukj ditlinxmii^ts 
k frffm tht l^rgt n^tmiMwiear i^m% tmd Iht UkA af hhnhttflti at iaiufc^ 
a} the tutileitf It^rm tkt pvtyfnK^phomtiUtv tdi. Wiih WiiiE^Ca stain ibc 
nmlr&plullc myelocyXM «how lilac or pink |;raniLl«B vitb a piuidnb 
aJmlxlurr, EoaiiKfibiJic nytrl